SNO and EANO practice guideline update: Anticonvulsant prophylaxis in patients with newly diagnosed brain tumors

Abstract

Objective To update the 2000 American Academy of Neurology (AAN) practice parameter on anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Methods Following the 2017 AAN methodologies, a systematic literature review utilizing PubMed, EMBASE, Cochrane, and Web of Science databases was performed. The studies were rated based on the AAN therapeutic or causation classification of evidence (Class I-IV). Results Thirty-seven articles were selected for final analysis. There were limited high level, Class I studies and mostly Class II and III studies. The AAN affirmed the value of these guidelines. Recommendations In patients with newly diagnosed brain tumors who have not had a seizure, clinicians should not prescribe anti-epileptic drugs (AEDs) to reduce the risk of seizures (Level A). In brain tumor patients undergoing surgery, there is insufficient evidence to recommend prescribing AEDs to reduce the risk of seizures in the peri- or postoperative period (Level C). There is insufficient evidence to support prescribing valproic acid or levetiracetam with the intent to prolong progression-free or overall survival (Level C). Physicians may consider use of levetiracetam over older AEDs to reduce side effects (Level C). There is insufficient evidence to support using tumor location, histology, grade, molecular/imaging features, when deciding whether or not to prescribe prophylactic AEDs (Level U).

Incidence, risk factors, and outcomes for early postoperative seizures in dogs with rostrotentorial brain tumors after intracranial surgery

“…The use of perioperative ACDs is common in human medicine, despite few studies suggesting that they are effective. 9 , 10 , 11 , 24 , 25 , 26 We hypothesized that additional perioperative ACD use would decrease the risk of EPS, but we did not detect a difference in EPS between groups that did or did not receive additional ACDs. Therefore, we did not detect a clear benefit of additional perioperative ACDs in this cohort of dogs.…”

“…Although our sample size was relatively small, our findings are similar to larger studies in humans, that have not documented a clear benefit to perioperative ACD prophylaxis. 10 , 11 Updated neuro‐oncology guidelines conclude that there is insufficient evidence that ACDs are useful in preventing seizures in human neurosurgical patients without previous epilepsy. 11 It is possible that the use of a perioperative ACD other than levetiracetam or phenobarbital would be more effective for preventing EPS.…”

“… 10 Currently, the cumulative evidence suggests that perioperative ACD do not decrease the risk of EPS, but the topic remains controversial because of the limited number of studies, numerous indications for the performance of intracranial surgery, and highly variable ACD protocols. 10 , 11 …”

SEOM-GEINO clinical guideline of systemic therapy and management of brain central nervous system metastases (2021)

“…Newer drugs, such as lacosamide and brivaracetam, can be also recommended since both have no reported drug interactions and their adverse effects are manageable [7,8]. There is insufficient evidence to recommend prophylaxis with AEDs [9]. Venous thromboembolism is significantly increased in BM patients but anti-coagulants can increase the risk of intracranial hemorrhage.…”

Levetiracetam as a sensitizer of concurrent chemoradiotherapy in newly diagnosed glioblastoma: An open‐label phase 2 study

“… 6 , 7 Recently, most guidelines recommend against prescribing antiepileptic drugs with the intent either to prevent a seizure or to prolong survival. 8 , 9 Nevertheless, there is a lack of high‐level evidence to conclude, and it has still been an interesting issue if certain AEDs would have anti‐cancer effects. Since the recent generation of AEDs has limited adverse effects with adequate central nervous system penetration, numerous neuro‐oncologists have prescribed AEDs to glioblastoma patients without an indication for seizure control.…”