Antiepileptic drugs for preventing seizures in people with brain tumors

Tremont‐Lukats, Ivo W.; Ratilal, Bernardo O; Armstrong, Terri S.; Gilbert, Mark R.

doi:10.1002/14651858.cd004424.pub2

Cited by 96 publications

(67 citation statements)

References 37 publications

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“…62 A single seizure usually necessitates the institution of drug treatment until the underlying tumor growth is controlled by tumor-specific therapy. 63 If no further seizure occurs after surgery and the tumor appears to be controlled by treatment, tapering of anticonvulsants should be attempted within the first weeks or months after surgery and further tumor-specific therapy.…”

Section: Epilepsymentioning

confidence: 99%

EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma

Weller

Bent

Hopkins

et al. 2014

The Lancet Oncology

658

532

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This guideline provides recommendations for diagnostic and therapeutic procedures for patients with malignant gliomas. We differentiate evidence-based standards from reasonable options or non-evidence-based measures that should no longer be considered. The recommendations herein should provide a framework and assurance for the choice of diagnostic procedures and therapeutic measures and aim to reduce complications from unnecessary treatment and cost. The guideline contributes to a critical appreciation of concurrent drugs with a focus on the controlled use of anticonvulsants and steroids. It should serve as a guideline for all professionals involved in the diagnostics and care of glioma patients and also as a source of knowledge for insurance companies and other institutions involved in the cost regulation of cancer care in Europe. Implementation of the recommendations summarised here will need interdisciplinary structures of care for patients with brain tumours and structured processes of diagnostic and therapeutic procedures. AF and DF report no conflicts of interest. FundingThe preparation of this guideline was not funded. The members of the task force did not receive compensation for their participation. 5 SummaryThis guideline provides recommendations for the diagnostic and therapeutic procedures for patients with malignant gliomas. It differentiates evidence-based standards from reasonable options or non-evidence-based measures that should no longer be considered. The recommendations herein shall provide a framework and assurance for the choice of diagnostic procedures and therapeutic measures and aim to reduce complications from unnecessary treatment and cost. The guideline will contribute to a critical appreciation of concurrent medications with a focus on the controlled use of anticonvulsants and steroids. It shall serve as a guideline for all professionals involved in the diagnostics and care of glioma patients and also as a source of knowledge for insurance companies and other institutions involved in the cost regulation of cancer care in Europe. Implementation of the recommendations summarized here will require interdisciplinary structures of care for brain tumor patients and structured processes of diagnostic and therapeutic procedures. Key wordsAnaplastic, glioma, glioblastoma, surgery, radiotherapy, temozolomide, bevacizumab Search strategy and selection criteriaThis guideline was prepared by a task force assembled by the Executive Committee of the European Association for Neuro-Oncology (EANO) in 2013. The task force was designed to represent the different disciplines involved in the diagnosis and care of malignant glioma patients as well as to reflect the multinational composition of EANO.References for this review were identified through searches of PubMed with the search terms "glioma", "anaplastic", "glioblastoma", "trial", "clinical", "radiotherapy" 6 and "chemotherapy" from January 2005 to January 2013. Articles were also identified through searches of the authors` own files. Onl...

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Section: Epilepsymentioning

confidence: 99%

EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma

Weller

Bent

Hopkins

et al. 2014

The Lancet Oncology

658

532

View full text Add to dashboard Cite

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“…Our study was aimed at assessing the therapeutic potential of AEDs in late emerging postoperative seizures, as placebo-controlled study and clear cut evidence on this issue are still lacking (25). International guidelines suggest not to use AEDs as seizure prevention in postsurgical patients (4,17), but in many cases routine use of anticonvulsant drugs remains the prevailing practice (6,10,11,17,21,27).…”

mentioning

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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“…Se ha demostrado que la radiación y la qui mioterapia tienen un efecto positivo en el control de las convulsiones relacionadas con tumores 92 . Con el objetivo de estimar la efectivi dad de la profilaxis anticonvulsivante y la tasa de efectos adversos en pacientes con tumores cerebrales, TremontLukats y col 93 realizaron en 2008 un metanálisis, el cual no encontró diferencias entre el grupo in tervenido (fenitoína, fenobarbital y dival proato sódico) y el grupo control en lo que respecta a prevención de la primera con vulsión, y el riesgo de evento adverso fue mayor en el grupo con medicación anticon vulsivante (número necesario para dañar= 3; RR 6,10, 95% CI 1,10 a 34,63; p= 0,046). Los autores concluyen que la evidencia es neutra, aplicando la fenitoína, fenobarbital y divalproato sódico.…”

Section: Manejo De Las Convulsionesunclassified

“…Desafortu nadamente hay carencia de evidencia ro busta que apoye la elección de medicación anticonvulsivante profiláctica en este tipo de pacientes. Aunque hay una tendencia a usar agentes anticonvulsivantes que no sean inductores enzimáticos, tales como el ácido valproico o valproato de sodio, lamo tigrina, etosuximida, gabapentina, pregaba lina, levetiracetam, tiagabine, rufinamida, lacosamida, zonisamida, vigabatrin, cloba zam y midazolam; sin embargo la evidencia comparativa para justificar su uso clínico es limitada, por lo que la decisión de co menzar un medicamento anticonvulsivante en forma de profilaxis está en función de la evaluación de los factores de riesgo indivi duales y de la discusión cuidadosa con los pacientes y sus familiares 93,94 . Por ejemplo, se podrían prescribir en pacientes cuyo tu mor está adyacente a la corteza cerebral, especialmente en las áreas frontal y tempo ral y preferiblemente que el anticonvulsi vante no sea inductor enzimático, para evi tar interacciones con otros medicamentos usados 11 .…”

Section: Manejo De Las Convulsionesunclassified

Manejo perioperatorio de tumores intracraneales: rol del neurocirujano

Polo-Torres¹,

Alvis-Miranda²,

Villa-Delgado³

et al. 2013

Anales Sis San Navarra

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revisiones0 Manejo perioperatorio de tumores intracraneales: rol del neurocirujanoPerioperative management of intracranial tumours: the neurosurgeon's role C. Polo-Torres, H.r. Alvis-Miranda, r. villa-Delgado, L.r. Moscote-salazar resUMen El manejo perioperatorio de los pacientes con tu mores cerebrales es un reto para el neurocirujano y todo el equipo quirúrgico. El médico debe considerar factores como el tipo de tumor, la extensión de la enfer medad, el tratamiento recibido, la presencia de comor bilidades y el pronóstico de la patología. La ejecución correcta de todos los aspectos implicados en el manejo perioperatorio en pacientes con tumores intracranea les contribuirá a prolongar la vida y a mejorar la calidad de vida de los pacientes.Palabras clave. Tumores cerebrales. Evaluación pre ope ratoria. Neurocirugía. ABsTrACTThe perioperative management of patients with brain tumours is a challenge for the neurosurgeon and the entire surgical team. The treating physician should consider factors such as the type of tumour, extent of disease, treatment received, the presence of comorbidities and prognosis of the disease itself. The successful execution of all aspects involved in perio perative management in patients with brain tumours will help prolong the life and improve the quality of life of patients.

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Antiepileptic drugs for preventing seizures in people with brain tumors

Cited by 96 publications

References 37 publications

EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma

EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma

Incidence and management of late postsurgical seizures in clinical practice.

Manejo perioperatorio de tumores intracraneales: rol del neurocirujano

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