Epilepsy meets cancer: when, why, and what to do about it?

Weller, Michael; Stupp, Roger; Wick, Wolfgang

doi:10.1016/s1470-2045(12)70266-8

Cited by 133 publications

(98 citation statements)

References 63 publications

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“…The choice of drug for patients requiring secondary prophylaxis is guided by various considerations. 64,65 The classical drugs include carbamazepine, This document does not address the competence to drive with a brain tumor because this is subject to country-specific regulations which are beyond the scope of this guideline.…”

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

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676

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

Self Cite

676

532

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“…The routinely prescribed AEDs (carbamazepine, phenytoin, and phenobarbital) induce cytochrome p450 liver enzymes and may interfere with metabolism of the chemotherapeutic agents used to treat brain tumors. 7 Prophylactic use of AEDs is not recommended for patients who do not present with seizures.…”

Section: Supportive Carementioning

confidence: 99%

Management of high-grade gliomas in the pediatric patient: Past, present, and future

Vanan

Eisenstat

2014

Neuro-Oncology Practice

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High-grade gliomas (HGGs) constitute 15% of all primary brain tumors in children and adolescents. Routine histopathological diagnosis is based on tissue obtained from biopsy or, preferably, from the resected tumor itself. The majority of pediatric HGGs are clinically and biologically distinct from histologically similar adult malignant gliomas; these differences may explain the disparate responses to therapy and clinical outcomes when comparing children and adults with HGG. The recently proposed integrated genomic classification identifies 6 distinct biological subgroups of glioblastoma (GBM) throughout the age spectrum. Driver mutations in genes affecting histone H3.3 (K27M and G34R/V) coupled with mutations involving specific proteins (TP53, ATRX, DAXX, SETD2, ACVR1, FGFR1, NTRK) induce defects in chromatin remodeling and may play a central role in the genesis of many pediatric HGGs. Current clinical practice in pediatric HGGs includes surgical resection followed by radiation therapy (in children aged . 3 years) with concurrent and adjuvant chemotherapy with temozolomide. However, these multimodality treatment strategies have had a minimal impact on improving survival. Ongoing clinical trials are investigating new molecular targets, chemoradiation sensitization strategies, and immunotherapy. Future clinical trials of pediatric HGG will incorporate the distinction between GBM molecular subgroups and stratify patients using group-specific biomarkers.

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“…The most common documented reasons for initiating peri-operative prophylaxis are related to tumour size, number of tumours, and location [25] . Tumours located in the frontal and temporal lobes are associated with higher seizure incidence.…”

Section: Discussionmentioning

confidence: 99%

“…Comorbidities such as electrolyte disturbance may be associated with a higher risk of seizure onset, however, there is no concrete evidence associating concurrent disease states, other than existing seizure disorder, with initiation of seizure prophylaxis [25] . Therefore, patients' comorbidities were not included as they do not directly impact seizure prophylaxis initiation.…”

Section: Study Population Inclusion Criteriamentioning

confidence: 99%

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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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Epilepsy meets cancer: when, why, and what to do about it?

Cited by 133 publications

References 63 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

Management of high-grade gliomas in the pediatric patient: Past, present, and future

Analysis of the Adherence to Seizure Prophylaxis Guidelines in Neurosurgery Patients

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