Efficacy and safety of prophylactic levetiracetam in supratentorial brain tumour surgery: a systematic review and meta‐analysis

Pourzitaki, Chryssa; Tsaousi, Georgia; Apostolidou, Eirini; Karakoulas, K.; Kouvelas, Dimitrios; Amaniti, Aikaterini

doi:10.1111/bcp.12926

Cited by 36 publications

(25 citation statements)

References 62 publications

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“…Side effects of levetiracetam, which is the current drug of choice for most neuro-oncological patients requiring anticonvulsive treatment, include e.g. fatigue, insomnia, mood and behaviour changes, headaches and decreased white blood counts 21 , 22 . These effects of have to be weighed against the risk of recurrent seizures with its attendant socioeconomic sequelae (e.g.…”

Section: Discussionmentioning

confidence: 99%

Early postoperative seizures (EPS) in patients undergoing brain tumour surgery

Ersoy

Ridwan

Grote

et al. 2020

Sci Rep

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early postoperative seizures (epS) are a common complication of brain tumour surgery. this paper investigates risk factors, management and clinical relevance of epS. We retrospectively analysed the occurrence of EPS, clinical and laboratory parameters, imaging and histopathological findings in a cohort of 679 consecutive patients who underwent craniotomies for intracranial tumours between 2015 and 2017. EPS were observed in 34/679 cases (5.1%), with 14 suffering at least one generalized seizure. patients with epS had a worse postoperative Karnofsky performance index (Kpi; with epS, KPI < 70 vs. 70-100: 11/108, 10.2% vs. 23/571, 4.0%; p = 0.007). Preoperative seizure history was a predictor for EPS (none vs. 1 vs. ≥ 2 seizures: p = 0.037). Meningioma patients had the highest EPS incidence (10.1%, p < 0.001). Cranial imaging identified a plausible cause in most cases (78.8%). In 20.6%, EPS were associated with a persisting new neurological deficit that could not otherwise be explained. 34.6% of the EPS patients had recurrent seizures within one year. EPS require an emergency work-up. Multiple EPS and recurrent seizures are frequent, which indicates that EPS may also reflect a more chronic condition i.e. epilepsy. EPS are often associated with persisting neurological worsening. Early postoperative seizures (EPS) are a common complication of brain tumour surgery. EPS are often categorized as acute symptomatic seizures 1,2. They are usually felt to reflect acute medical or surgical conditions that may require emergency treatment. This includes haemorrhages, infectious complications and electrolyte disturbances, but also systemic infections and cardiopulmonary disorders resulting in hypotension and hypoxia. Hence, EPS may have potentially severe consequences. They may result in significant and often persisting (neurological) morbidity and reduced quality of life. Furthermore, they usually prolong the patient's hospital stay. Potential negative consequences include a delayed transfer for rehabilitation therapy, an overall prolonged rehabilitation and, importantly, delayed adjuvant therapy. This latter aspect is of considerable importance e.g. in patients with gliomas and metastasis who will often not realize the benefits of surgery if adjuvant therapy is withhold. In addition, many patients with brain metastases require more or less urgent treatment for their systemic disease. There is also the issue of distinguishing between incidental or acute symptomatic seizures with no or a very low risk of recurrent seizures and true postoperative chronic epilepsy 1-3. The latter condition requires chronic treatment with antiepileptic drugs and comes with relevant socioeconomic sequelae such as restriction of driving privileges. This may be a particularly important issue for patients with benign tumours such as many meningiomas who have a good chance of a surgical cure of their tumour. In such cases, the risk of recurrent seizures may well be their only (neurological) health concern 4,5. There is a growing interest in tumour-assoc...

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Section: Discussionmentioning

confidence: 99%

Early postoperative seizures (EPS) in patients undergoing brain tumour surgery

Ersoy

Ridwan

Grote

et al. 2020

Sci Rep

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“…Newer generations of AEDs, e.g. Levetiracetam, have less adverse effects, have a potentially synergistic effect on oncologic treatment, as well as an antiemetic and neuro-protective effect compared to the older AEDs [3,4,14].…”

Section: Introductionmentioning

confidence: 99%

The risk of developing seizures before and after primary brain surgery of low- and high-grade gliomas

Bech

Seyedi

Schulz

et al. 2018

Clinical Neurology and Neurosurgery

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“…1 Furthermore, neither the tumor type nor the type of surgery influenced seizure activity. 30 Pourzitaki et al reported a meta-analysis of prophylactic levetiracetam usage in patients with brain tumors; 23 two of four studies included in the analysis investigated epilepsy patients with a his- tory of seizure disorders. Another meta-analysis by Yuan et al also included studies and patients with and without seizure history.…”

Section: Discussionmentioning

confidence: 99%

Phenytoin versus levetiracetam as prophylaxis for postcraniotomy seizure in patients with no history of seizures: systematic review and meta-analysis

Lee

Koo

Han

et al. 2019

Journal of Neurosurgery

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OBJECTIVE De novo seizure following craniotomy (DSC) for nontraumatic pathology may adversely affect medical and neurological outcomes in patients with no history of seizures who have undergone craniotomies. Antiepileptic drugs (AEDs) are commonly used prophylactically in patients undergoing craniotomy; however, evidence supporting this practice is limited and mixed. The authors aimed to collate the available evidence on the efficacy and tolerability of levetiracetam monotherapy and compare it with that of the classic AED, phenytoin, for DSC. METHODS PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies that compared levetiracetam with phenytoin for DSC prevention. Inclusion criteria were adult patients with no history of epilepsy who underwent craniotomy with prophylactic usage of phenytoin, a comparator group with levetiracetam treatment as the main treatment difference between the two groups, and availability of data on the numbers of patients and seizures for each group. Patients with brain injury and previous seizure history were excluded. DSC occurrence and adverse drug reaction (ADR) were evaluated. Seizure occurrence was calculated using the Peto odds ratio (POR), which is the relative effect estimation method of choice for binary data with rare events. RESULTS Data from 7 studies involving 803 patients were included. The DSC occurrence rate was 1.26% (4/318) in the levetiracetam cohort and 6.60% (32/485) in the phenytoin cohort. Meta-analysis showed that levetiracetam is significantly superior to phenytoin for DSC prevention (POR 0.233, 95% confidence interval [CI] 0.117-0.462, p< 0.001). Subgroup analysis demonstrated that levetiracetam is superior to phenytoin for DSC due to all brain diseases (POR 0.129, 95% CI 0.039-0.423, p = 0.001) and tumor (POR 0.282, 95% CI 0.117-0.678, p = 0.005). ADRs in the levetiracetam group were cognitive disturbance, thrombophlebitis, irritability, lethargy, tiredness, and asthenia, whereas rash, anaphylaxis, arrhythmia, and hyponatremia were more common in the phenytoin group. The overall occurrence of ADR in the phenytoin (34/466) and levetiracetam (26/432) groups (p = 0.44) demonstrated no statistically significant difference in ADR occurrence. However, the discontinuation rate of AEDs due to ADR was 53/297 in the phenytoin group and 6/196 in the levetiracetam group (POR 0.266, 95% CI 0.137-0.518, p < 0.001). CONCLUSIONS Levetiracetam is superior to phenytoin for DSC prevention for nontraumatic pathology and has fewer serious ADRs that lead to discontinuation. Further high-quality studies that compare levetiracetam with placebo are necessary to provide evidence for establishing AED guidelines.

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Efficacy and safety of prophylactic levetiracetam in supratentorial brain tumour surgery: a systematic review and meta‐analysis

Cited by 36 publications

References 62 publications

Early postoperative seizures (EPS) in patients undergoing brain tumour surgery

Early postoperative seizures (EPS) in patients undergoing brain tumour surgery

The risk of developing seizures before and after primary brain surgery of low- and high-grade gliomas

Phenytoin versus levetiracetam as prophylaxis for postcraniotomy seizure in patients with no history of seizures: systematic review and meta-analysis

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