The role of prophylactic antiepileptic drugs for seizure prophylaxis in meningioma surgery: A systematic review

Islim, Abdurrahman I; McKeever, Stephen; Kusu-Orkar, Ter-Er; Jenkinson, Michael D.

doi:10.1016/j.jocn.2017.05.020

Cited by 29 publications

(20 citation statements)

References 46 publications

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“…Hence, although brain invasion by meningiomas was shown to correlate with increased intraoperative cleavability in 1 series, 16 our data provide no evidence that dissection of these lesions from the invaded cortex facilitates perioperative seizures. Moreover, in addition to general recommendations about the perioperative prescription of AEDs for patients with meningioma, 8 our results provide no rationale for considering the microscopic evidence of brain invasion in the decision making about prophylactic postoperative AEDs for patients with meningioma.…”

Section: Brain Invasion and Postoperative Seizuresmentioning

confidence: 64%

“…The frequency of new postoperative seizures in our series was 5% and therefore similar to that found in previously published series. 8 Among all analyzed variables, only tumor volume (but not PTBE or brain invasion) was significantly correlated with the incidence of new postoperative seizures. Similarly, the proportions of postoperatively seizure-free patients did not differ on the basis of whether the patient had an invasive or noninvasive meningioma.…”

Section: Brain Invasion and Postoperative Seizuresmentioning

confidence: 90%

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Brain invasion and the risk of seizures in patients with meningioma

Heß

Spille²,

Adeli

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Identification of risk factors for perioperative epilepsy remains crucial in the care of patients with meningioma. Moreover, associations of brain invasion with clinical and radiological variables have been largely unexplored. The authors hypothesized that invasion of the cortex and subsequent increased edema facilitate seizures, and they compared radiological data and perioperative seizures in patients with brain-invasive or noninvasive meningioma. METHODS Correlations of brain invasion with tumor and edema volumes and preoperative and postoperative seizures were analyzed in univariate and multivariate analyses. RESULTS Totals of 108 (61%) females and 68 (39%) males with a median age of 60 years and harboring totals of 92 (52%) grade I, 79 (45%) grade II, and 5 (3%) grade III tumors were included. Brain invasion was found in 38 (22%) patients and was absent in 138 (78%) patients. The tumors were located at the convexity in 72 (41%) patients, at the falx cerebri in 26 (15%), at the skull base in 69 (39%), in the posterior fossa in 7 (4%), and in the ventricle in 2 (1%); the median tumor and edema volumes were 13.73 cm (range 0.81-162.22 cm) and 1.38 cm (range 0.00-355.80 cm), respectively. As expected, edema volume increased with rising tumor volume (p < 0.001). Brain invasion was independent of tumor volume (p = 0.176) but strongly correlated with edema volume (p < 0.001). The mean edema volume in noninvasive tumors was 33.0 cm, but in invasive tumors, it was 130.7 cm (p = 0.008). The frequency of preoperative seizures was independent of the patients' age, sex, and tumor location; however, the frequency was 32% (n = 12) in patients with invasive meningioma and 15% (n = 21) in those with noninvasive meningioma (p = 0.033). In contrast, the probability of detecting brain invasion microscopically was increased more than 2-fold in patients with a history of preoperative seizures (OR 2.57, 95% CI 1.13-5.88; p = 0.025). In univariate analyses, the rate of preoperative seizures correlated slightly with tumor volume (p = 0.049) but strongly with edema volume (p = 0.014), whereas seizure semiology was found to be independent of brain invasion (p = 0.211). In multivariate analyses adjusted for age, sex, tumor location, tumor and edema volumes, and WHO grade, rising tumor volume (OR 1.02, 95% CI 1.00-1.03; p = 0.042) and especially brain invasion (OR 5.26, 95% CI 1.52-18.15; p = 0.009) were identified as independent predictors of preoperative seizures. Nine (5%) patients developed new seizures within a median follow-up time of 15 months after surgery. Development of postoperative epilepsy was independent of all clinical variables, including Simpson grade (p = 0.133), tumor location (p = 0.936), brain invasion (p = 0.408), and preoperative edema volume (p = 0.081), but was correlated with increasing preoperative tumor volume (p = 0.004). Postoperative seizure-free rates were similar among patients with invasive and those with noninvasive meningioma (p = 0.372). CONCLUSIONS Brain invasion was identified as a new an...

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Section: Brain Invasion and Postoperative Seizuresmentioning

confidence: 64%

Section: Brain Invasion and Postoperative Seizuresmentioning

confidence: 90%

Brain invasion and the risk of seizures in patients with meningioma

Heß

Spille²,

Adeli

et al. 2019

Journal of Neurosurgery

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“…De-novo seizures occurred in 29 seizure-naïve patients (13.5%), 9 (4.2%) of which arose in the early postoperative period (within 1 week of surgery), which is slightly higher than the pooled frequency of 2.7% in a recent systematic review [ 7 ]. Midline shift, previously shown to play a role in epilepsy development following evacuation of intracranial haemorrhages and resection of cerebral metastases [ 22 , 23 ], was likewise independently associated with postoperative seizures in seizure-naïve meningioma patients.…”

Section: Discussionmentioning

confidence: 92%

“…The general consensus, comprising reviews and one retired practice parameter by the American Academy of Neurology (AAN), is that AEDs should not be routinely used for prophylaxis [ 3 , 4 , 7 , 8 , 30 ], and specific guidelines for the administration of AEDs in meningiomas are yet to be formulated. As a result, a wide variety of AED practices are observed, firstly at a local level in our institute and secondly on a wider scale as the AANS/CNS survey demonstrated [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…Antiepileptic drugs (AEDs) are indicated for the treatment of brain tumour-related seizures, however, there still remains no consensus on whether prophylactic AEDs should be prescribed in seizure-naïve patients to prevent the development of postoperative seizures [ 4 ]. Epilepsy in meningioma patients is a major cause of morbidity and mortality [ 5 , 6 ], but the rate at which new seizures develop in patients undergoing meningioma surgery varies, and the efficacy of AEDs in reducing post-operative seizure rates remains questionable [ 7 , 8 ]. Furthermore, drug-related side effects, which can impair quality of life (QoL) and neurocognitive function (NCF), occur in up to half of patients [ 5 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Postoperative seizures in meningioma patients: improving patient selection for antiepileptic drug therapy

et al. 2018

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BackgroundEpilepsy is a major cause of morbidity and mortality in meningioma patients. The aims of this study were to determine which factors predispose meningioma patients to developing perioperative seizures and to understand the impact of antiepileptic drugs.MethodsPatients treated for a histologically-confirmed intracranial meningioma at the authors’ institution between 2010 and 2015 were retrospectively examined. Clinical and imaging data were assessed. Multivariate analysis was performed using binary logistic regression. The effect of antiepileptic treatment was assessed using survival analysis.ResultsTwo hundred and eighty-three patients met the selection criteria; seizures were present in 68 preoperatively (24%) and in 48 patients (17%) following surgery. Of the 68 with preoperative seizures, 19 continued to have them, whereas de-novo seizures arose postoperatively in 29 seizure-naïve patients. Risk factors of postoperative seizures were convexity location (OR 2.05 [95% CI 1.07–3.98], p = 0.030), fronto-parietal location (OR 4.42 [95% CI 1.49–13.16], p = 0.007) and preoperative seizures (OR 2.65 [95% CI 1.37–5.24], p = 0.005). The two locations, in addition to the presence of midline shift on preoperative imaging (OR 4.15 [95% CI 1.54–11.24], p = 0.005), were significantly correlated with postoperative seizures in seizure-naïve patients. Antiepileptic treatment in patients with those risk factors reduced the possibility of seizures at any time point within the 1st year postoperatively by approximately 40%, although this did not meet statistical significance.ConclusionProphylactic antiepileptic treatment might be warranted in seizure-naïve meningioma patients with ≥ 1 risk factor. High-quality randomised controlled trials are required to verify those factors and to define the role of antiepileptics in meningioma practice.

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Antiepileptic drugs as prophylaxis for postcraniotomy seizures

Greenhalgh

Weston

Dündar

et al. 2018

Cochrane Database of Systematic Reviews

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There is limited, low-quality evidence to suggest that AED treatment administered prophylactically is either effective or not effective in the prevention of postcraniotomy (early or late) seizures. The current evidence base is limited due to the different methodologies employed in the trials and inconsistencies in the reporting of outcomes including deaths and adverse events. Further evidence from good-quality, contemporary trials is required in order to assess the clinical effectiveness of prophylactic AED treatment compared to placebo or no treatment, or other AEDs in preventing postcraniotomy seizures in this select group of patients.

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The role of prophylactic antiepileptic drugs for seizure prophylaxis in meningioma surgery: A systematic review

Cited by 29 publications

References 46 publications

Brain invasion and the risk of seizures in patients with meningioma

Brain invasion and the risk of seizures in patients with meningioma

Postoperative seizures in meningioma patients: improving patient selection for antiepileptic drug therapy

Antiepileptic drugs as prophylaxis for postcraniotomy seizures

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