EBS presentation: The effectiveness of

prophylactic anti-epileptic drugs on adult glioma patients

Scholar: Dr Jonathan LiSenior Scholar: Dr Andrew Davidson

Mr RM • 82 yo male

• Presented with 2 months of subtle word finding difficulties

• Histopath result of grade 3 anaplastic astrocytoma

• Symptom free post op

• Represented day 12 post op with seizure involving transient right hemiparesis and dysphasia

• Symptoms resolved on phenytoin

Clinical question

• Does anti-epileptic drugs (AEDs) prevent new onset of seizures in adult patients with glioma?

• P patients with glioma

• I anticonvulsant prophylaxis

• C placebo or no anticonvulsant

• O seizure prevention

Search Strategy• Cochrane

• “Anti-epileptic” and “brain tumors”

• one Cochrane review available from 2008

• Medline

• Combine : Brain tumo*r, Anti-epileptic, prophylaxis

• Limit to 2007 onwards

• Scopus

• To check and trace citations

Search results• Medline:

• 3 case reports• 6 papers on pharmacology• 2 review article on epilepsy and brain tumour• 1 Cochrane review• 1 retrospective case series

• Scopus:• 1 prospective cohort case series

Cochrane Review Paper:Antiepileptic drugs for preventing seizures in people with brain tumours (Tremont-Lukats et al.,

2008)

• Objectives:

• To determine if seizure prophylaxis with AEDs is effective in people with brain tumour

• To estimate the adverse event rate from prophylactic AEDs

• Methods:

• Include controlled clinical trials with random allocation

• Types of participants included a wide range of brain tumors

• Intervention was prophylaxis vs. no prophylaxis

• Excluded studies comparing two AEDs agents

Cochrane Review Paper:Antiepileptic drugs for preventing seizures in people with brain tumours (Tremont-Lukats et al.,

2008)

• Their search results:

• Identified 26 studies from 1454 citations

• 5 trials met their inclusion criteria

• 21 studies excluded

Cochrane Review Paper:Antiepileptic drugs for preventing seizures in people with brain tumours (Tremont-Lukats et al.,

2008)

Cochrane Review Paper:Antiepileptic drugs for preventing seizures in people with brain tumours (Tremont-Lukats et al.,

2008)

34%

40%

37%

12%

40%

Patientwith

glioma (%)

Cochrane Review Paper:Antiepileptic drugs for preventing seizures in people with brain tumours (Tremont-Lukats et al.,

2008)

• A prospective cohort study of 64 patients who underwent surgical treatment for primary or recurrent glioma (level IV evidence)

• 54 patients (84%) had new diagnosis of glioma

• 15 patients (23%) were WHO grade III histology

• Outcomes were onset of first seizure and correlation with histology

• Mean follow up was 18.7 ± 11 months; median: 19 months

• 27 of 64 patients (42%) had seizure on onset of and recurrence glioma

• Those that were diagnosed with seizure were either commenced on phenytoin or keppra

• Of the 35 patients that did not receive AEDs none had seizure on follow up (12) or at their death (23).

Epilepsy in cerebral glioma: timing of appearance and histological correlations

(Rosati et al., 2009)

• A retrospective chart review of 164 patients with newly histologically diagnosed glioma (level IV evidence)

• Prophylactic AEDs was given to 27% of patients

• Peri-operative seizures (within 1 week) occured in 2 patients (3% of patients) without AEDs

• No peri-operative seizured for patients with prophylaxis

• Prophylactic AEDs were continued for > 1 week for in 30 patients 18% of patients

• Temporal lobe tumours were more likely to receive prophylaxis (50% vs 20%)

Use of peri-operative anti-epileptic drugs in patients with newly diagnosed high grade

malignant glioma: a single center experience (Lwu et al., 2009)

Conclusion• Does anti-epileptic drugs (AEDs) prevent new onset of

seizures in adult patients with glioma?

• “The evidence is neutral, neither for nor against seizure prophylaxis, in people with brain tumours”

• This evidence only applies to the certain AEDs

• It is unknown whether the same efficacy holds for newer AEDs