Background: The effectiveness of antiepileptic prophylaxis in patients with newly diagnosed high‑grade glioma is debated. Craniotomy, surgical manipulation and bleeding are believed to favor the onset of seizures and, therefore, perioperative antiepileptic drugs (AEDs) are generally used. Nevertheless, evidence to initiate preoperative AED prophylaxis are weak. Aim: Aim of this paper was to evaluate the need for AED prophylaxis in surgically‑treated malignant glioma patients without history of seizures. Materials and Methods: We conducted a retrospective, two‑center cohort study to assess the effectiveness of preoperative AED prophylaxis. Patients were divided in two groups: one with AED preoperative administration and the other without. Because of its non‑hepatic metabolism, levetiracetam (LEV) was chosen. Logistic regression models were used to investigate the odds ratio for each group. The explanatory variables included the treatment received, sex, age, and site of lesion. The outcome measure of successful LEV prophylaxis was seizure vs. no seizure post‑operatively, at three and six months after surgery. Results: Our results showed that LEV prophylaxis was not a significant predictor of seizure occurrence, although the regression coefficient indicated a slight reduction in seizure risk following LEV administration. Patient’s age was a significant predictor of seizure occurrence. Younger patients had a higher risk of seizure in the six months post‑surgery. Conclusions: We conclude that AEDs prophylaxis does not provide a substantial benefit to surgically treated high‑grade glioma patients and should not be administered routinely. Further investigations are required to detect subgroups of patients at higher risk of developing seizures in order to selectively administer AED.

A retrospective two-center study of antiepileptic prophylaxis in patients with surgically treated high-grade gliomas

GARBOSSA, Diego;PANCIANI, PIER PAOLO;ANGELERI, ROMINA;BATTAGLIA, Luigi Sebastiano;AJELLO, MARCO;AGNOLETTI, Alessandro;DUCATI, Alessandro;
2013

Abstract

Background: The effectiveness of antiepileptic prophylaxis in patients with newly diagnosed high‑grade glioma is debated. Craniotomy, surgical manipulation and bleeding are believed to favor the onset of seizures and, therefore, perioperative antiepileptic drugs (AEDs) are generally used. Nevertheless, evidence to initiate preoperative AED prophylaxis are weak. Aim: Aim of this paper was to evaluate the need for AED prophylaxis in surgically‑treated malignant glioma patients without history of seizures. Materials and Methods: We conducted a retrospective, two‑center cohort study to assess the effectiveness of preoperative AED prophylaxis. Patients were divided in two groups: one with AED preoperative administration and the other without. Because of its non‑hepatic metabolism, levetiracetam (LEV) was chosen. Logistic regression models were used to investigate the odds ratio for each group. The explanatory variables included the treatment received, sex, age, and site of lesion. The outcome measure of successful LEV prophylaxis was seizure vs. no seizure post‑operatively, at three and six months after surgery. Results: Our results showed that LEV prophylaxis was not a significant predictor of seizure occurrence, although the regression coefficient indicated a slight reduction in seizure risk following LEV administration. Patient’s age was a significant predictor of seizure occurrence. Younger patients had a higher risk of seizure in the six months post‑surgery. Conclusions: We conclude that AEDs prophylaxis does not provide a substantial benefit to surgically treated high‑grade glioma patients and should not be administered routinely. Further investigations are required to detect subgroups of patients at higher risk of developing seizures in order to selectively administer AED.
61
2
131
137
Antiepileptic Drugs; Glioma; Levetiracetam; Prophylaxis; Seizures; Surgery; Adult; Aged; Anticonvulsants; Brain Neoplasms; Craniotomy; Female; Glioma; Humans; Male; Middle Aged; Piracetam; Postoperative Period; Retrospective Studies; Seizures; Treatment Outcome; Neurology (clinical); Neurology
Garbossa, Diego; Panciani, Pier Paolo; Angeleri, Romina; Battaglia, Luigi; Tartara, Fulvio; Ajello, Marco; Agnoletti, Alessandro; Versari, Pietro; Ducati, Alessandro; Fontanella, Marco; Spena, Giannantonio
File in questo prodotto:
File Dimensione Formato  
articolo levetiracetam.pdf

Accesso aperto

Tipo di file: PDF EDITORIALE
Dimensione 460.97 kB
Formato Adobe PDF
460.97 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1589315
Citazioni
  • ???jsp.display-item.citation.pmc??? 4
  • Scopus 22
  • ???jsp.display-item.citation.isi??? 20
social impact