Efficacy and Safety of Levetiracetam in Patients With Glioma

Rosati, Anna; Buttolo, Luciano; Stefini, Roberto; Todeschini, Alice; Cenzato, Marco; Padovani, Alessandro

doi:10.1001/archneurol.2009.335

Cited by 89 publications

(58 citation statements)

References 23 publications

(34 reference statements)

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“…Additionally, there was no decline in overall quality of life, overall health or cognitive function, as assessed by EORTC quality of life questionnaire and MMST ( Figure 1). This corroborates the recent results on safety and tolerability from retrospective or smaller studies applying LEV in brain tumor patients or in patients undergoing any supratentorial neurosurgery (6,9,10,18,22,23,30).…”

Section: Discussionsupporting

confidence: 89%

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Intravenous and oral levetiracetam in patients with a suspected primary brain tumor and symptomatic seizures undergoing neurosurgery: the HELLO trial

et al. 2011

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BACKGROUND: Levetiracetam (LEV) is a newer anticonvulsant with a favorable safety profile. There seem to be no relevant drug interactions, and an intravenous formulation is available. Therefore, LEV might be a suitable drug for the perioperative anticonvulsive therapy of patients with suspected brain tumors undergoing neurosurgery. METHODS: In this prospective study (NCT00571155) patients with suspected primary brain tumors and tumor-related seizures were perioperatively treated with oral and intravenous LEV up to 4 weeks before and until 4 weeks after a planned neurosurgical procedure. FINDINGS: Thirty patients with brain tumor-related seizures and intended neurosurgery were included. Three patients did not undergo the scheduled surgery after enrollment, and two patients were lost to follow-up. Therefore, 25 patients were fully evaluable. After initiation of therapy with LEV, 100% of the patients were seizure-free in the pre-surgery phase (3 days up to 4 weeks before surgery), 88% in the 48 h post-surgery phase and 84% in the early follow-up phase (48 h to 4 weeks post surgery). Treatment failure even after dose escalation to 3,000 mg/day occurred in three patients. No serious adverse events related to the treatment with LEV occurred. CONCLUSION: Our data show the feasibility and safety of oral and intravenous LEV in the perioperative treatment of tumor-related seizures. Although this was a single arm study, the efficacy of LEV appears promising. Considering the side effects and interactions of other anticonvulsants, LEV seems to be a favorable option in the perioperative treatment of brain tumor-related seizures.

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Section: Discussionsupporting

confidence: 89%

“…LEV was the first new AED with an intravenous formulation being available (1,16,17,21). Therefore, LEV might be a first choice for the treatment of brain tumorrelated epilepsy (3,18,23 …”

Section: Introductionmentioning

confidence: 99%

Intravenous and oral levetiracetam in patients with a suspected primary brain tumor and symptomatic seizures undergoing neurosurgery: the HELLO trial

et al. 2011

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“…In a uncontrolled prospective study, LEV was shown to be well tolerated and provided a good seizure improvement in 17 patients with BTE (Usery, Michael et al, 2009). Further studies confirmed the good profile of LEV in BTE Rosati, Buttolo et al ;Maschio, Albani et al 2006;Newton, Goldlust et al 2006) and metastatic brain tumor epilepsy Newton, Dalton et al 2007). Several experts recommend use of LEV as first monotherapy in BTE Vecht and Wilms ;Vecht and van Breemen 2006;van Breemen, Rijsman et al 2009), although others still suggest valproic acid, lamotrigine and topiramate as first choice treatments (van Breemen, Wilms et al 2007).…”

Section: -5 Antiepileptic Pharmacotherapymentioning

confidence: 57%

Brain tumor epilepsy: A reappraisal and six remaining issues to be debated

Vercueil

2011

Revue Neurologique

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Epilepsy associated with brain tumors presents with specific features deserving medical attention : 1) although commonly reported in patients with brain tumor, either as revealing mode or as a remote complication, limited knowledge is available regarding their epidemiology, clinical evolution, surgical outcome, physiopathology and treatment, providing only clues for clinical management. 2) seizures appear even more threatening for patients and care-givers, providing seizures could meant tumor progression and recurrence. This factor adds to the negative impact epilepsy carry on quality of life measures. 3) pharmacotherapy is complicated by the use of chemotherapy and interaction between antiepileptic drugs and antineoplastic agents are frequent and potentially harmful. 4) the high incidence of epilepsy enlights the question of prophylaxy with antiepileptic drugs, in patients without seizures, or during the perioperative period, and after surgery, when gross total resection has been achieved. This article attempts to provide the reader with an overview of brain tumor epilepsy in its specific aspects and to comment on some remaining issues.

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“…Levetiracetam-Overall side-effects of levetiracetam in EBT are seen in 5-10% of patients, often of psychiatric nature, including psychosis, depression, and aggressive behavior (Merrell et al, 2010b;Rosati et al, 2010;Maschio et al, 2011b;Rossetti et al, 2014). On the other hand, levetiracetam shows improvement in cognitive functioning in both EBT and general epilepsy (Helmstaedter and Witt, 2008;de Groot et al, 2013).…”

Section: Adverse Effects Of Aedsmentioning

confidence: 99%

Epilepsy and Brain Tumors

Newton

Maschio²,

Pritikin³

2015

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Seizures are common in patients with brain tumors, and epilepsy can significantly impact patient quality of life. Therefore, a thorough understanding of rates and predictors of seizures, and the likelihood of seizure freedom after resection, is critical in the treatment of brain tumors. Among all tumor types, seizures are most common with glioneuronal tumors (70-80%), particularly in patients with frontotemporal or insular lesions. Seizures are also common in individuals with glioma, with the highest rates of epilepsy (60-75%) observed in patients with low-grade gliomas located in superficial cortical or insular regions. Approximately 20-50% of patients with meningioma and 20-35% of those with brain metastases also suffer from seizures. After tumor resection, approximately 60-90% are rendered seizure-free, with most favorable seizure outcomes seen in individuals with glioneuronal tumors. Gross total resection, earlier surgical therapy, and a lack of generalized seizures are common predictors of a favorable seizure outcome. With regard to anticonvulsant medication selection, evidence-based guidelines for the treatment of focal epilepsy should be followed, and individual patient factors should also be considered, including patient age, sex, organ dysfunction, comorbidity, or cotherapy. As concomitant chemotherapy commonly forms an essential part of glioma treatment, enzyme-inducing anticonvulsants should be avoided when possible. Seizure freedom is the ultimate goal in the treatment of brain tumor patients with epilepsy, given the adverse effects of seizures on quality of life.

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Efficacy and Safety of Levetiracetam in Patients With Glioma

Abstract: To evaluate the efficacy and safety of levetiracetam in the management of epilepsy in patients with glioma.Design: A prospective study in hospitalized patients with a new diagnosis of glioma.

Cited by 89 publications

References 23 publications

Intravenous and oral levetiracetam in patients with a suspected primary brain tumor and symptomatic seizures undergoing neurosurgery: the HELLO trial

Intravenous and oral levetiracetam in patients with a suspected primary brain tumor and symptomatic seizures undergoing neurosurgery: the HELLO trial

Brain tumor epilepsy: A reappraisal and six remaining issues to be debated

Epilepsy and Brain Tumors

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