Oxcarbazepine monotherapy in patients with brain tumor-related epilepsy: open-label pilot study for assessing the efficacy, tolerability and impact on quality of life

Abstract

We conducted a prospective, observational study to verify the efficacy, tolerability and impact on quality of life, mood and global neurocognitive performances of oxcarbazepine monotherapy in patients with brain tumor-related epilepsy (BTRE). Patients were followed for 12 months. We recruited 25 patients (11 females 14 males; mean age 49.7) affected with BTRE (17 de novo patients and 7 in monotherapy with other antiepileptics) and introduced oxcarbazepine monotherapy because of uncontrolled seizures and/or side effects. At first visit, patients underwent neurological examination, Qolie 31P V2, EORTC QLQC30, Zung self-depression rating scale (ZSDRS) and adverse events profile. A seizure diary was given to each patient. Follow-up duration was 1-12 months (mean 7.1 months, 5 patients died and 10 dropped out). Totals of 16 patients underwent both chemotherapy and radiotherapy, 4 chemotherapy only, 1 radiotherapy only, and 4 did not undergo any systemic therapy. Mean dosage of oxcarbazepine was 1,230 mg/day (min 600, max 2,100 mg/day). McNemar's test showed a significant difference in seizure freedom rate (P = 0.002) between baseline and final follow-up in the intent-to-treat population. Six patients (24%) had serious side effects and one patient (4%) mild. Logistic regression revealed that, in our study, chemotherapy and radiotherapy did not affect the efficacy of OXC in seizure outcome (P = 0.658). The test evaluation at final follow-up showed a significant improvement in ZSDRS (P = 0.011) and no change over time. Oxcarbazepine seems to be efficacious in controlling seizures and in improving mood in patients with BTRE, but special caution should be taken when it is administered during radiotherapy.

European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma

“…29 A number of uncontrolled cohort studies, that measured depressive symptoms as secondary outcomes on rating scales, provide limited evidence in favour of methylphenidate 25,30 , oxcarbazapine 31 , bupropion SR 32 , gingko biloba 33 and donepezil 27 . It remains unknown whether any of these treatments are effective for clinically significant depressive disorder, or indeed any better than placebo.…”

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

“…45,46 The risk of severe skin toxicity is increased when patients are treated with phenytoin or carbamazepine or oxcarbazepine not only in combination with procarbazine, but also with radiotherapy. 47 Finally, EI-AED decrease the bioavailability of steroids, necessitating careful clinical monitoring when EI-AED are newly introduced in steroid-dependent brain tumor patients. Conversely, when EI-AED are replaced by non-EI-AED, it should be assessed whether steroid doses can be lowered.…”

Measurement of side effects of anti-epileptic drugs (AEDs) in adults with intellectual disability: A systematic review

“…Table 2 summarizes studies identified which have a focus on intellectual disability. [16], [17], [18], [20]] whilst other studies showed no or little improvement [ [35], [82], [85] ] .…”