Antiseizure medication for brain metastasis-related epilepsy: Findings of optimal choice from a retrospective cohort

Sánchez-Villalobos, José Manuel; Aledo‐Serrano, Ángel; Serna-Berna, Alfredo; Salinas-Ramos, Juan; Martínez‐Alonso, Emma; Pérez-Vicente, José Antonio; Baños, Miguel Alcaraz

doi:10.1016/j.eplepsyres.2021.106812

Cited by 6 publications

(7 citation statements)

References 20 publications

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“…The prevalence of seizures reported in previous studies ranged from 20 to 35%, being more frequent in patients with BMs of lung cancer and melanoma. Other major factors known to increase the risk of seizures would be: supratentorial and cortico/subcortical junction localization and the presence of hemorrhagic components in BMs [14,[31][32][33][34][35]. In our study, the prevalence was 30.6%, with the most frequent etiology in the overall BTRE cohort being of pulmonary origin (51.35%).…”

Section: Discussionmentioning

confidence: 54%

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Volumetric Modulated Arc Therapy for Radiosurgery of Brain Metastases: A Single-Center Study

Sánchez-Villalobos,

Serna-Berna,

Salinas-Ramos

et al. 2023

Applied Sciences

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Whole-brain radiation therapy and stereotactic radiosurgery are two treatment modalities commonly utilized to treat brain metastases (BMs). The aim of this study is to retrospectively analyze the main radio-oncologic and clinical-demographic aspects of a cohort of BM patients treated with Volumetric Modulated Arc Therapy for radiosurgery (VMAT-RS). This is a cross-sectional observational design study with a retrospective review of the medical records of patients with brain metastases treated with VMAT-RS between 2012 and 2018. Clinical and demographic data, with special attention to sex, age, primary tumor, brain tumor-related epilepsy (BTRE), number and brain location of BMs, Karnofsky Performance Status (KPS), the updated DS-GPA prognostic index, and the survival estimated according to the Kaplan–Meier model from the date of radiosurgery, were analyzed. One hundred and twenty-one patients with 229 BMs were treated with VMAT-RS. Patients presented 1–4 BMs, which were treated with five non-coplanar VMAT arcs. Sixty-eight percent of the patients had lung cancer, and 35% of the BMs were in the frontal lobe. The proportion of local control was 88.5%. BTRE prevalence was 30.6%. The median survival time (MST) was 7.7 months. In the multivariate analysis of the Cox regression model, KPS ≥ 70 (HRKPS < 70 = 2.59; p = 0.001) and higher DS-GPA (HRDS-GPAII = 0.55, p = 0.022; HRDS-GPAIII-IV = 0.38, p = 0.006) were associated with improved survival. In the univariate analysis, primary tumor, age, and the presence of metastases in the posterior fossa (PFBMs) were also significant. In conclusion, the VMAT-RS is a technique with an overall survival rate comparable to other radiosurgery techniques. The median survival is significantly longer for those with higher KPS and DS-GPA. Other variables, such as the type of primary tumor, age, and PFBMs, could also influence survival, although further studies are needed.

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Section: Discussionmentioning

confidence: 54%

“…Epilepsy related to tumor lesions is present in 20-35% of patients with BMs. Among the main risk factors described are metastases of melanoma and pulmonary origin, those with hemorrhagic components, and cortico-subcortical localization [14,15].…”

Section: Introductionmentioning

confidence: 99%

Volumetric Modulated Arc Therapy for Radiosurgery of Brain Metastases: A Single-Center Study

Sánchez-Villalobos,

Serna-Berna,

Salinas-Ramos

et al. 2023

Applied Sciences

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“…55 Because of its safety profile, lack of drug-drug interactions, and effectiveness in reducing tumor-related seizures, levetiracetam is the most common antiseizure medication used in patients with brain tumors. 56 In fact, large cohort data from patients with gliomas support levetiracetam and valproate monotherapy, or in combination, over other antiseizure drugs, 57,58 particularly over enzyme-inducing options. 59 Data from preclinical and small cohort studies suggest that some antiseizure medications (eg, valproate, levetiracetam, oxcarbazepine, perampanel) may also have antiproliferative effects; however, there are no large clinical trials demonstrating these properties to be clinically significant.…”

Section: Seizuresmentioning

confidence: 99%

“…Because of its safety profile, lack of drug-drug interactions, and effectiveness in reducing tumor-related seizures, levetiracetam is the most common antiseizure medication used in patients with brain tumors 56 . In fact, large cohort data from patients with gliomas support levetiracetam and valproate monotherapy, or in combination, over other antiseizure drugs, 57,58 particularly over enzyme-inducing options 59 .…”

Section: Indirect Tumor-mediated Complicationsmentioning

confidence: 99%

Neuro-oncologic Emergencies

Maciel,

Busl

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE Neuro-oncologic emergencies have become more frequent as cancer remains one of the leading causes of death in the United States, second only to heart disease. This article highlights key aspects of epidemiology, diagnosis, and management of acute neurologic complications in primary central nervous system malignancies and systemic cancer, following three thematic classifications: (1) complications that are anatomically or intrinsically tumor-related, (2) complications that are tumor-mediated, and (3) complications that are treatment-related. LATEST DEVELOPMENTS The main driver of mortality in patients with brain metastasis is systemic disease progression; however, intracranial hypertension, treatment-resistant seizures, and overall decline due to increased intracranial burden of disease are the main factors underlying neurologic-related deaths. Advances in the understanding of tumor-specific characteristics can better inform risk stratification of neurologic complications. Following standardized grading and management algorithms for neurotoxic syndromes related to newer immunologic therapies is paramount to achieving favorable outcomes. ESSENTIAL POINTS Neuro-oncologic emergencies span the boundaries of subspecialties in neurology and require a broad understanding of neuroimmunology, neuronal hyperexcitability, CSF flow dynamics, intracranial compliance, and neuroanatomy.

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“…Levetiracetam is frequently prescribed in BTRE patients, being one of the most widely used first-line ASM (Sánchez-Villalobos et al, 2021a). Numerous studies have shown the efficacy of levetiracetam in BTRE patients both in monotherapy (Dinapoli et al, 2009;Merrell et al, 2010;Rosati et al, 2010;Usery et al, 2010;Maschio et al, 2011b;De Groot et al, 2011;Bähr et al, 2012;Rossetti et al, 2014;Berntsson et al, 2018;Cardona et al, 2018;Casas Parera et al, 2019;Kerkhof et al, 2019;Ius et al, 2020;Solomons et al, 2020) and in polytherapy (Wagner et al, 2003;Maschio et al, 2006;Newton et al, 2006;Van Breemen et al, 2009;Haggiagi (Bonney et al, 2016), d (Englot et al, 2016a, e (You et al, 2012), f (Lee et al, 2010), g (Goldstein and Feyissa, 2018), h (Michelucci et al, 2013), i (Singh et al, 2020, j (Wolpert et al, 2020), k (Wirsching et al, 2016), l (Englot et al, 2016b), m (Fox et al, 2019).…”

Section: Levetiracetammentioning

confidence: 99%

Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios

et al. 2022

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Epilepsy represents a challenge in the management of patients with brain tumors. Epileptic seizures are one of the most frequent comorbidities in neuro-oncology and may be the debut symptom of a brain tumor or a complication during its evolution. Epileptogenic mechanisms of brain tumors are not yet fully elucidated, although new factors related to the underlying pathophysiological process with possible treatment implications have been described. In recent years, the development of new anti-seizure medications (ASM), with better pharmacokinetic profiles and fewer side effects, has become a paradigm shift in many clinical scenarios in neuro-oncology, being able, for instance, to adapt epilepsy treatment to specific features of each patient. This is crucial in several situations, such as patients with cognitive/psychiatric comorbidity, pregnancy, or advanced age, among others. In this narrative review, we provide a rationale for decision-making in ASM choice for neuro-oncologic patients, highlighting the strengths and weaknesses of each drug. In addition, according to current literature evidence, we try to answer some of the most frequent questions that arise in daily clinical practice in patients with epilepsy related to brain tumors, such as, which patients are the best candidates for ASM and when to start it, what is the best treatment option for each patient, and what are the major pitfalls to be aware of during follow-up.

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Antiseizure medication for brain metastasis-related epilepsy: Findings of optimal choice from a retrospective cohort

Cited by 6 publications

References 20 publications

Volumetric Modulated Arc Therapy for Radiosurgery of Brain Metastases: A Single-Center Study

Volumetric Modulated Arc Therapy for Radiosurgery of Brain Metastases: A Single-Center Study

Neuro-oncologic Emergencies

Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios

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