Seizure Prophylaxis in Patients With Brain Tumors: A Meta-analysis

Sirven, Joseph I; Wingerchuk, Dean M.; Drazkowski, Joseph F.; Lyons, Mark; Zimmerman, Richard S.

doi:10.4065/79.12.1489

Cited by 245 publications

(147 citation statements)

References 26 publications

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“…First generation AEDs can control early seizures but seem not to reduce incidence of late seizures. Studies with newer AEDs are scarce, but interest is rapidly increasing (13,16,22). The American Academy of Neurology recommends not to treat subjects with cerebral neoplasms and traumatic brain injury who have not had seizures beyond 1 week postoperatively or postinjury (4).…”

Section: Bartolini E Et Al: An Observational Longitudinal Study In Nmentioning

confidence: 99%

Incidence and management of late postsurgical seizures in clinical practice.

Bartolini¹,

Lenzi²,

Vannozzi³

et al. 2012

Turkish Neurosurgery

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AIm: Seizures are a frequent complication in patients who undergo neurosurgery, and can complicate the post-operative course and deteriorate patients' quality of life. Evidence on the prophylactic anticonvulsant therapy after craniotomy is still lacking. mATeRIAL and meTHods:We undertook an observational longitudinal study following neurosurgical supratentorial interventions, to evaluate seizures onset or persistence, and differences in effectiveness between conventional and newer AEDs. ResuLTs:A total of 100 consecutive subjects were enrolled. Each patient underwent a neurosurgical treatment by craniotomy. Pre-operative seizures occurred in 33% patients, early seizures in 13%. Late seizures occurred in 46 patients. At baseline (1 month after surgery) and during follow up the main therapeutic regimen was monotherapy. At last follow up adjustment of antiepileptic regimen or AED dosage had rendered 27 subjects seizure free. People taking newer AEDs at baseline maintain the same antiepileptic regimen more often than patients taking conventional AEDs; late seizures tended to have a higher incidence in the latter group. Adverse events from baseline AEDs were reported by 17% of patients. CoNCLusIoN:In this study population late postsurgical seizures had a remarkable occurrence. Newer AEDs were continued more often than conventional AEDs, with a better tolerability but no significant differences in late seizures incidence. BuLGuLAR: Çalışmaya arka arkaya toplam 100 hasta kaydedildi. Her hastada kraniyotomi şeklinde bir nöroşirürji tedavisi gerçekleştirildi. Preoperatif havaleler hastaların %33'ünde ve erken havaleler %13'ünde görüldü. Geç havaleler 46 hastada görüldü. Başlangıçta (cerrahiden 1 ay sonra) ve takip sırasında ana terapötik rejim monoterapiydi. Son takipte antiepileptik rejim veya antiepileptik ilaç dozunun ayarlanmasıyla 27 hastada havaleler ortadan kaybolmuştu. Başlangıçta daha yeni antiepileptik ilaçları alan kişilerde geleneksel antiepileptiklere göre daha sık olarak aynı antiepileptik rejime devam edildiği görüldü; geç havalelerin insidansı ikinci grupta daha yüksekti. Başlangıç antiepileptik ilaçlar nedeniyle advers olaylar hastaların %17'sinde bildirildi. soNuÇ: Bu çalışma, popülasyonunda cerrahi sonrası geç havalelerin insidansı önemli ölçüdeydi. Daha yeni antiepileptik ilaçlar geleneksel antiepileptiklere göre daha sık devam edildi ve daha iyi tolere edildiler ama geç havale insidansında önemli bir fark yoktu.

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Section: Bartolini E Et Al: An Observational Longitudinal Study In Nmentioning

confidence: 99%

Incidence and management of late postsurgical seizures in clinical practice.

Bartolini¹,

Lenzi²,

Vannozzi³

et al. 2012

Turkish Neurosurgery

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“…In addition, the incidence and severity of AED related side effects were noted to be higher in brain tumour patients compared to a general population of patients receiving AEDs [7] . Subsequent metaanalyses and systematic reviews conducted after the release of these guidelines further support this recommendation [5,12,13,18,19] . One of the major limitations in interpreting the available evidence is that many patients who experienced seizures while receiving AED prophylaxis had sub-therapeutic levels.…”

Section: Analysis Of the Adherence To Seizure Prophylaxis Guidelines mentioning

confidence: 97%

“…Four of the five trials showed no benefit of seizure prophylaxis [19] . More recently, a 2011 metaanalysis concluded that their review did not support the routine use of prophylactic AEDs in patients undergoing supratentorial meningioma resection [12] .…”

Section: Analysis Of the Adherence To Seizure Prophylaxis Guidelines mentioning

confidence: 99%

Analysis of the Adherence to Seizure Prophylaxis Guidelines in Neurosurgery Patients

Liao

Chiu

et al. 2016

International Journal of Neurology Research

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BACKGROUND:In 2000, the American Academy of Neurology guidelines recommended that long-term seizure prophylaxis should not be routine in patients with newly diagnosed brain tumours and that if anti-epileptic drugs (AEDs) are used, they should be tapered and discontinued after 7 days post-operatively. Recent data shows that most newly diagnosed brain tumour patients continue to receive prophylactic AED. AIM: This study aimed to examine the seizure prophylaxis practices at Trillium Health Partners -Mississauga Hospital, a regional neurosurgery centre located in Mississauga, Ontario, Canada. MATERIALS AND METHODS:A retrospective chart review was performed in adult patients with a newly diagnosed brain tumour who underwent neurosurgery between January 2010 and December 2014. RESULTS: 690 patient charts were screened and 235 patients were excluded, most commonly due to seizure on admission. Overall, 28% (n = 129) of 455 included patients over 5 years received seizure prophylaxis. Phenytoin was the most common prophylactic agent used. The average post-operative length of stay was 7.98 days and the average duration of therapy was 8.73 days. In 61% of patients who received prophylaxis, it was unknown whether the AED was continued in the long-term. The drug cost savings to the organization over 5 years if patients had not received seizure prophylaxis was $ 4287.52. The patient characteristics most strongly correlated with receiving seizure prophylaxis were increasing tumour size and decreasing number of tumours. CONCLUSION: 1 in 3 patients at Trillium Health Partners received seizure prophylaxis. Increased awareness of the organization's practice patterns may help prevent unnecessary long-term AED use.Key words: Seizure; Prophylaxis; Neurosurgery; Adherence; Guidelines; Anti-epileptic Drugs INTRODUCTIONIn Canada, 55,000 patients live with a brain tumour and an additional 10,000 patients are newly diagnosed with a primary or metastatic brain tumour each year [1] . Brain tumours are associated with high morbidity and mortality rates, therefore effective treatment is necessary to decrease both morbidity and mortality. However, treatment for brain tumours is complicated by their vast diversity in pathology, location and recurrence rate [1] . Seizure is a common and debilitating complication for brain ORIGINAL ARTICLE Analysis of the Adherence to Seizure Prophylaxis Guidelines in Neurosurgery PatientsXueqing ( International Journal of Neurology Research tumour patients, due to physical injury, emotional stress, anxiety, and impaired activities of daily living [2,3] . Up to half of patients with brain tumours present to hospital with seizure as a manifestation of the disease, and another 10-30% will develop seizures [4,5] . Seizures resulting from brain tumourssignificantly decrease patients' quality of life [6] . Antiepileptic drugs (AEDs) have traditionally been used to both treat and prevent seizures in brain tumourpatients. The majority of research conducted supports the usage of AED to prevent seizures in brain ...

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“…Neurosurgeons mostly use antiepileptic prophylaxis because intralesional bleeding, increase of edema and local electrolytic/pH changes may provoke seizure. However, the neuro-oncology literature does not support the prophylactic use of antiepileptics that do not prevent epileptogenesis [69] and most of these drugs may reduce antitumoral drug levels and chemotherapy efficacy [70]. Phenytoin is an old anticonvulsant drug commonly used in neurosurgery for its feasibility and rapid titration.…”

Section: Epilepsy Antiepileptic Drugs: Chemotherapy Interactionmentioning

confidence: 99%