Seizures in patents with primary central nervous system lymphoma: Prevalence and associated features

Fox, Jonah; Ajinkya, Shaun; Houston, Peter; Lindhorst, Scott; Cachia, David; Olar, Adriana; Kutluay, Ekrem

doi:10.1016/j.jns.2019.03.011

Cited by 12 publications

(8 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…HDMTX is an integral component in the treatment of CNS lymphoma and prevention of CNS relapse 28 . Patients with primary CNS lymphoma are at an increased risk for seizures, and it has been reported that up to one‐third of patients will experience a clinical seizure during the course of the disease 29 . Historically, levetiracetam has been widely used in this setting because of its efficacy and minimal drug‐drug interactions, particularly with HDMTX 7,12,30 .…”

Section: Discussionmentioning

confidence: 99%

Lack of drug interaction between levetiracetam and high‐dose methotrexate in patients with lymphoma

et al. 2021

View full text Add to dashboard Cite

Study Objective To determine whether there is a drug‐drug interaction precluding the concomitant use of levetiracetam and high‐dose methotrexate (HDMTX). Design Retrospective analysis. Setting Large academic tertiary care medical center. Patients Adult lymphoma patients who received HDMTX as a 4‐h infusion with or without concomitant levetiracetam. Measurements and Main Results Generalized estimating equations clustered on patient were used to assess each outcome. The primary outcome was the incidence of delayed MTX elimination (MTX level >1 µmol/L at 48 h). Secondary outcomes included incidence of acute kidney injury (AKI) and hospital length of stay (LOS). The 430 included patients receiving 1993 doses of HDMTX had a median (IQR) age of 66 (57.5, 72.6) years, 88 (20.5%) received concomitant levetiracetam with at least one dose of MTX, 267 (62.1%) were male, and 397 (92.3%) were Caucasian. HDMTX doses ranged from 1 to 8 g/m2. The most common lymphoma diagnoses were systemic diffuse large B‐cell lymphoma (DLBCL; 58.5%) and systemic DLBCL with central nervous system (CNS) involvement (32.8%). Rates of delayed elimination with and without levetiracetam were 13.4% and 16.3%, respectively (OR = 0.80, 95% CI 0.47–1.34, p = 0.39). AKI occurred in 15.6% and 17.0% of patients with and without concomitant levetiracetam, respectively (OR = 0.83, 95% CI 0.52–1.33, p = 0.28). The median LOS with and without levetiracetam was 4.2 and 4.1 days, respectively (p = 0.039). On multivariable analyses, only age, body surface area, diagnosis of systemic DLBCL with CNS involvement, serum creatinine, hemoglobin, total bilirubin, and dose of HDMTX were associated with delayed elimination. Conclusions High‐dose methotrexate administered with concomitant levetiracetam was not associated with increased risk for delayed MTX elimination or AKI. These results support that levetiracetam and HDMTX are safe for coadministration.

show abstract

Section: Discussionmentioning

confidence: 99%

Lack of drug interaction between levetiracetam and high‐dose methotrexate in patients with lymphoma

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Levetiracetam is frequently prescribed in BTRE patients, being one of the most widely used first-line ASM (Sánchez-Villalobos et al, 2021a). Numerous studies have shown the efficacy of levetiracetam in BTRE patients both in monotherapy (Dinapoli et al, 2009;Merrell et al, 2010;Rosati et al, 2010;Usery et al, 2010;Maschio et al, 2011b;De Groot et al, 2011;Bähr et al, 2012;Rossetti et al, 2014;Berntsson et al, 2018;Cardona et al, 2018;Casas Parera et al, 2019;Kerkhof et al, 2019;Ius et al, 2020;Solomons et al, 2020) and in polytherapy (Wagner et al, 2003;Maschio et al, 2006;Newton et al, 2006;Van Breemen et al, 2009;Haggiagi (Bonney et al, 2016), d (Englot et al, 2016a, e (You et al, 2012), f (Lee et al, 2010), g (Goldstein and Feyissa, 2018), h (Michelucci et al, 2013), i (Singh et al, 2020, j (Wolpert et al, 2020), k (Wirsching et al, 2016), l (Englot et al, 2016b), m (Fox et al, 2019).…”

Section: Levetiracetammentioning

confidence: 99%

“…seizure freedom frequency after optimized medical treatment.DNET: Dysembryoplastic neuroepithelial tumor. a ( van Breemen et al, 2007 ), b ( Ertürk Çetin et al, 2017 ), c ( Bonney et al, 2016 ), d ( Englot et al, 2016a ), e ( You et al, 2012 ), f ( Lee et al, 2010 ), g ( Goldstein and Feyissa, 2018 ), h ( Michelucci et al, 2013 ), i ( Singh et al, 2020 ), j ( Wolpert et al, 2020 ), k ( Wirsching et al, 2016 ), l ( Englot et al, 2016b ), m ( Fox et al, 2019 ).…”

Section: Antiseizure Medication For Brain Tumor-related Epilepsymentioning

confidence: 99%

Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios

et al. 2022

View full text Add to dashboard Cite

Epilepsy represents a challenge in the management of patients with brain tumors. Epileptic seizures are one of the most frequent comorbidities in neuro-oncology and may be the debut symptom of a brain tumor or a complication during its evolution. Epileptogenic mechanisms of brain tumors are not yet fully elucidated, although new factors related to the underlying pathophysiological process with possible treatment implications have been described. In recent years, the development of new anti-seizure medications (ASM), with better pharmacokinetic profiles and fewer side effects, has become a paradigm shift in many clinical scenarios in neuro-oncology, being able, for instance, to adapt epilepsy treatment to specific features of each patient. This is crucial in several situations, such as patients with cognitive/psychiatric comorbidity, pregnancy, or advanced age, among others. In this narrative review, we provide a rationale for decision-making in ASM choice for neuro-oncologic patients, highlighting the strengths and weaknesses of each drug. In addition, according to current literature evidence, we try to answer some of the most frequent questions that arise in daily clinical practice in patients with epilepsy related to brain tumors, such as, which patients are the best candidates for ASM and when to start it, what is the best treatment option for each patient, and what are the major pitfalls to be aware of during follow-up.

show abstract

“…Tumor site had an impact on the reasons for ICU admission, as the higher rate of aspiration pneumonia observed in patients with brainstem tumor suggest direct impairment of anatomic structures extending from the brainstem nuclei to nerves innervating laryngeal muscles. The relatively low proportion of ICU admissions for coma with seizures (11%) observed in PCNSL patients, compared to patients with other primary malignant brain tumors, especially gliomas (26-41%) [12,13], could also be explained by a higher rate of subcortical tumor sites [32][33][34]. Tumor stage also had an impact on the reasons for ICU admission, as patients with progressive disease were more frequently admitted for coma secondary to intracranial hypertension without seizures (e.g., tumor swelling, perilesional edema, tumor bleeding) or a direct mass-effect on the brainstem (in the case of infratentorial tumor).…”

Section: Comparison With Existing Datamentioning

confidence: 99%

Clinical features and outcome of patients with primary central nervous system lymphoma admitted to the intensive care unit: a French national expert center experience

et al. 2021

View full text Add to dashboard Cite

Introduction To describe the reasons for intensive care unit (ICU) admission and to evaluate the outcomes and prognostic factors of patients with primary central nervous system lymphoma (PCNSL) admitted to the ICU. Patients and methods Retrospective observational cohort study of 101 PCNSL patients admitted to 3 ICUs over a twodecade period. Results Acute respiratory failure, mainly secondary to aspiration pneumonia and Pneumocystis jirovecii pneumonia, was the leading reason for ICU admission (33%). Aspiration pneumonia was more common in patients with brainstem tumor (67% vs. 0%, p < 0.001), whereas patients with intracranial hypertension were more frequently admitted for coma without seizures (61% vs. 9%, p = 0.004). Hospital and 6-month mortality were 47% and 53%, respectively. In multivariate analysis, admission for coma without seizures (OR 7.28), cancer progression (OR 3.47), mechanical ventilation (OR 6.58) and vasopressors (OR 4.07) were associated with higher 6-month mortality. Karnofsky performance status prior to ICU admission was independently associated with lower 6-month mortality (OR 0.96). Discussion Six-month survival of PCNSL patients admitted to the ICU appears to be relatively favorable (around 50%) and the presence of PCNSL alone is not a relevant criterion for ICU refusal. Predictive factors of mortality may help clinicians to make optimal triage decisions.

show abstract

Seizures in patents with primary central nervous system lymphoma: Prevalence and associated features

Cited by 12 publications

References 18 publications

Lack of drug interaction between levetiracetam and high‐dose methotrexate in patients with lymphoma

Lack of drug interaction between levetiracetam and high‐dose methotrexate in patients with lymphoma

Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios

Clinical features and outcome of patients with primary central nervous system lymphoma admitted to the intensive care unit: a French national expert center experience

Contact Info

Product

Resources

About