Levetiracetam versus phenytoin for seizure prophylaxis during and early after craniotomy for brain tumours: a phase II prospective, randomised study

Iuchi, Toshihiko; Kuwabara, Kiyoto; Matsumoto, Minako; Kawasaki, Koichiro; Hasegawa, Yuzo; Sakaida, Tsukasa

doi:10.1136/jnnp-2014-308584

Cited by 70 publications

(59 citation statements)

References 30 publications

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“…In past studies, levetiracetam was described as a potentially beneficial alternative to conventional AEDs in patients with brain tumors, which is based on comparatively rare drug interactions and side effects [34, 35]. Therefore, this drug is increasingly used in the neurosurgical context, allowing formation of a subgroup large enough for statistically meaningful analysis in the present study (Table 1).…”

Section: Discussionmentioning

confidence: 97%

The variability of motor evoked potential latencies in neurosurgical motor mapping by preoperative navigated transcranial magnetic stimulation

et al. 2017

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BackgroundRecording of motor evoked potentials (MEPs) is used during navigated transcranial magnetic stimulation (nTMS) motor mapping to locate motor function in the human brain. However, factors potentially underlying MEP latency variability in neurosurgical motor mapping are vastly unknown. In the context of this study, one hundred brain tumor patients underwent preoperative nTMS-based motor mapping of the tumor hemisphere between 2010 and 2013. Fourteen predefined predictor variables were recorded, and MEP latencies of abductor pollicis brevis muscle (APB), abductor digiti minimi muscle (ADM), and flexor carpi radialis muscle (FCR) were analyzed using linear mixed-effect multiple regression analysis with the forward step-wise model comparison approach.ResultsCommon factors (relevant to APB, ADM, and FCR) for MEP latency variability were gender, most likely due to body height, and antiepileptic drug (AED) intake. Muscle-specific factors (relevant to APB, ADM, or FCR) for MEP latency variability were resting motor threshold (rMT), tumor side, and tumor location.ConclusionsBased on a large cohort of neurosurgical patients, this study provides data on a wide range of clinical factors that may underlie MEP latency variability. The factors that significantly contributed to MEP latency variability should be standardly recorded and taken into consideration during neurosurgical motor mapping.

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Section: Discussionmentioning

confidence: 97%

The variability of motor evoked potential latencies in neurosurgical motor mapping by preoperative navigated transcranial magnetic stimulation

et al. 2017

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“…In a small randomized open-label trial comparing levetiracetam to pregabalin in patients with primary BTs, retention rates were 59% in the levetiracetam group, and 41% in the pregabalin group [27]. In a randomized, open-label trial comparing levetiracetam to phenytoin, the incidence of seizures was significantly less in the levetiracetam group (1.4%) than in the phenytoin group (15.1%) [28]. Among all first-choice AEDs in our patient population, the most favorable prognostic factor for time in therapy, prior to its substitution due to SE, seems to have been treatment with a non-EI-AED, particularly with levetiracetam.…”

Section: Discussionmentioning

confidence: 99%

Patterns of care of brain tumor-related epilepsy. A cohort study done in Italian Epilepsy Center

et al. 2017

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Epilepsy is the most common comorbidity in patients with brain tumors. Study Aims: To define characteristics of brain tumor-related epilepsy (BTRE) patients and identify patterns of care. Nationwide, multicenter retrospective cohort study. Medical records of BTRE patients seen from 1/1/2010 to 12/31/2011, followed for at least one month were examined. Information included age, sex, tumor type/treatments, epilepsy characteristics, antiepileptic drugs (AEDs). Time to modify first AED due to inefficacy and/or toxicity was assessed with the Kaplan-Meier method and Cox proportional hazard models were used to identify predictors of treatment outcome. Enrolled were 808 patients (447 men, 361 women) from 26 epilepsy centers. Follow-up ranged 1 to 423 months (median 18 months). 732 patients underwent surgery, 483 chemotherapy (CT), 508 radiotherapy. All patients were treated with AEDs. Levetiracetam was the most common drug. 377 patients (46.7%) were still on first drug at end of follow-up, 338 (41.8%) needed treatment modifications (uncontrolled seizures, 229; side effects, 101; poor compliance, 22). Treatment discontinuation for lack of efficacy was associated with younger age, chemotherapy, and center with <20 cases. Treatment discontinuation for side effects was associated with female sex, enzyme-inducing drugs and center with > 20 cases. About one-half of patients with BTRE were on first AED at end of follow-up. Levetiracetam was the most common drug. A non enzyme-inducing AED was followed by a lower risk of drug discontinuation for SE.

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“…Most of the patients had gliomas, and only a few meningioma patients, were included (seven of 146). In this study, AEDs were given for 7 days after surgery [19]. Another randomized controlled study compared phenytoin and levetiracetam using a different AED prophylactic strategy, as patients took AEDs for 3 months.…”

Section: Prophylactic Aed Treatment In Short and Long Termmentioning

confidence: 98%

Intracranial meningiomas and seizures: a review of the literature

et al. 2015

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Levetiracetam versus phenytoin for seizure prophylaxis during and early after craniotomy for brain tumours: a phase II prospective, randomised study

Abstract: UMIN13971.

Cited by 70 publications

References 30 publications

The variability of motor evoked potential latencies in neurosurgical motor mapping by preoperative navigated transcranial magnetic stimulation

The variability of motor evoked potential latencies in neurosurgical motor mapping by preoperative navigated transcranial magnetic stimulation

Patterns of care of brain tumor-related epilepsy. A cohort study done in Italian Epilepsy Center

Intracranial meningiomas and seizures: a review of the literature

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