Phenytoin, Levetiracetam, and Pregabalin in the Acute Management of Refractory Status Epilepticus in Patients with Brain Tumors

Abstract

Background There were nearly 700,000 patients in the United States in 2010 living with brain tumor diagnoses. The incidence of seizures in this population is as high as 70% and is historically difficult to control. Approximately 30-40% of brain tumors patients who present with status epilepticus (SE) will not respond to typical therapy consisting of benzodiazepines and phenytoin (PHT), resulting in patients with refractory status epilepticus (RSE). RSE is usually treated with anesthetic doses of propofol or midazolam infusions. This therapy can have significant risk, particularly in patients with cancer. Methods A retrospective chart review was performed on 23 patients with primary or metastatic brain tumors whose SE was treated with intravenous PHT, levetiracetam (LEV), and oral pregabalin (PGB). Results In all the patients under study, PHT or LEV was used as first-line therapy. PGB was typically used as thirdline treatment. The median daily dose of PGB was 375 mg (usually divided BID or TID), and the median daily dose of LEV 3000 mg (usually divided BID). Cessation of SE was seen in 16/23 (70%) after administration of PHT, LEV, and PGB. SE was aborted, on average, 24 h after addition of the third antiepileptic drug. Only one patient in the responder group required intubation. Mortality rate was zero in the responder group. No adverse reactions to this medication regimen were observed.Conclusion Our study suggests that the administration of PHT, LEV, and PGB in brain tumor patients with RSE is safe and highly effective.

Outcome predictors for status epilepticus—what really counts

“…39 For patients with SE who have primary or metastatic brain tumours, treatment with phenytoin or leveti racetam as first-line antiepileptic drugs (AEDs) and pregabalin as a second-line AED was found to control epilepsy in 70% of cases, with 0% mortality in responders. 40 History of epilepsy Results from a study of a rural Chinese cohort showed that the risk of premature death in people with convulsive Box 1 | Outcome factors in SE: demographics, aetiology and clinical characteristics…”

Levetiracetam Effect on Adult-Onset Temporal Lobe Epilepsy With Positive Voltage-Gated Potassium Channel Antibody

“…26 Swisher et al suggested that the combination use of PHT, LEV, and pregabalin (PGB) in brain tumor patients with refractory status epilepticus is safe and highly effective. 27 As demonstrated by these cases, we proposed that LEV may be a useful AEDs for seizure induced by LE. And this application did not have an obvious psychiatric adverse side effect.…”

The Role of Levetiracetam in Treatment of Seizures in Brain Tumor Patients

“…The researchers concluded that LTG penetrates well into brain and tumor tissue and had a moderately high protein binding (15). It has been shown that pregabalin has been used as adjunctive therapy in this subgroup of patients although limited data are available, which is the case with most other newer agents (16). …”

“…There were no adverse reactions to Trifecta reported. The authors concluded that in patients with brain tumors presenting in RSE that Trifecta use is highly effective and safe (16). …”