Antiepileptic Drugs in the Management of Cerebral Metastases

Monsour, Meredith A; Kelly, Patrick; Chambless, Lola B.

doi:10.1016/j.nec.2020.06.008

Cited by 3 publications

(2 citation statements)

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“…Patients with neuropathic pain are treated with neuropathic agents, such as duloxetine and gabapentin [ 149 ]. Antiepileptic medication is indicated only in patients who experience seizures [ 150 ].…”

Section: Lmm Treatmentmentioning

confidence: 99%

Leptomeningeal Disease (LMD) in Patients with Melanoma Metastases

Khaled

Tarhini

Smalley

et al. 2023

Cancers

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Leptomeningeal disease (LMD) is a devastating complication caused by seeding malignant cells to the cerebrospinal fluid (CSF) and the leptomeningeal membrane. LMD is diagnosed in 5–15% of patients with systemic malignancy. Management of LMD is challenging due to the biological and metabolic tumor microenvironment of LMD being largely unknown. Patients with LMD can present with a wide variety of signs and/or symptoms that could be multifocal and include headache, nausea, vomiting, diplopia, and weakness, among others. The median survival time for patients with LMD is measured in weeks and up to 3–6 months with aggressive management, and death usually occurs due to progressive neurologic dysfunction. In melanoma, LMD is associated with a suppressive immune microenvironment characterized by a high number of apoptotic and exhausted CD4+ T-cells, myeloid-derived suppressor cells, and a low number of CD8+ T-cells. Proteomics analysis revealed enrichment of complement cascade, which may disrupt the blood–CSF barrier. Clinical management of melanoma LMD consists primarily of radiation therapy, BRAF/MEK inhibitors as targeted therapy, and immunotherapy with anti-PD-1, anti-CTLA-4, and anti-LAG-3 immune checkpoint inhibitors. This review summarizes the biology and anatomic features of melanoma LMD, as well as the current therapeutic approaches.

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Section: Lmm Treatmentmentioning

confidence: 99%

Leptomeningeal Disease (LMD) in Patients with Melanoma Metastases

Khaled

Tarhini

Smalley

et al. 2023

Cancers

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“…Constant monitoring of AEs during the follow-up of patients with BM and epilepsy must be considered of paramount importance, not only because AEs have a heavy impact on the quality of life of these patients (5), but also because decreased compliance due to AEs may lead to worse seizure control (1,35,45,46). In our retrospective study, despite all patients undergoing oncological treatments during ASM therapy, only 2 of 42 changed ASM therapy for AEs (1 owing to agitation with LEV and one due to psychiatric disorders with VPA).…”

Section: Discussionmentioning

confidence: 99%

Impact of epilepsy and its treatment on brain metastasis from solid tumors: A retrospective study

et al. 2022

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IntroductionRetrospective observational study on medical records of patients with epilepsy related brain metastases (BM) to evaluate efficacy, safety and possible interaction with cancer treatment of different anti-seizure medications (ASMs) and the risk of seizures.Materials and methodsWe consecutively reviewed all medical records of epilepsy-related BM patients from 2010 to 2020 who were followed for at least one month at the Brain Tumour-related Epilepsy Center of the IRCCS Regina Elena National Cancer Institute Rome, Italy.ResultsWe selected 111 cancer patients. Of these, only 42 had at least undergone a second neurological examination. In the whole population, 95 (85.2%) had seizures and 16 patients had no seizures (14.4%). The most frequently first ASM prescribed was LEV (40.5%). We observed a significant correlation between tumor site and probability of having seizures, but not between seizure type and age (>65 or <65 years). Among 42 patients, 26 were administered levetiracetam, followed by oxcarbazepine. Until the last follow-up, 19 never changed the first ASM, maintained the same dosage and remained seizure free. After a median of 7 months, 16 (38.1%) required changes in therapeutic treatment due to inefficacy. At the last follow-up, 24 patients (57.1%) were seizure free. Eighteen patients (42.8%) never achieved freedom from seizures despite had at least 2 therapy changes. Two patients changed ASM due to adverse events and 1 to phenobarbital owing to the interaction with cancer treatment. The mean daily dose of first ASM in all 42 patients was very close to the Defined Daily Dose (DDD).ConclusionIn BM patients seizure incidence could be underestimated; a team evaluation performed by oncologist and neurologist together, could guarantee an accurate taking care of both oncological illness and epilepsy, in this fragile patient population. More than 50% of our patients respond to monotherapy with new generation ASMs. Furthermore we deemed in patients receiving chemotherapy the choice of ASM should consider possible interactions with antitumor therapies, for this reason newer generation ASMs should be the preferred choice. It is necessary to get close to the DDD before considering an ASM ineffective in seizure control.

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