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A meta-analysis: Do prophylactic antiepileptic drugs in patients with brain tumors decrease the incidence of
Xiangyi Kong1, Jian Guan1, Yi Yang1
1Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Hutong of Dongcheng District, Beijing 100730, PR China.
Background:
Seizures are a potentially devastating complication of brain tumors. Several studies in the past have attempted to demonstrate that prophylactic antiepileptic drugs (AEDs) in patients with brain tumors can decrease the incidence of seizures. However, it is currently unclear whether AEDs should be routinely administered to patients with brain tumors who have never had a seizure.
Objective:
A meta-analysis of randomized trials was conducted to estimate the effectiveness of seizure prophylaxis in people with brain tumors.
Methods:
A range of electronic databases were searched (1966-2014): MEDLINE, the Cochrane Library Database, EMBASE, CINAHL, Web of Science and the Chinese Biomedical Database (CBM) without language restrictions. Two independent reviewers assessed trials for eligibility and quality, and meta-analysis was performed using the STATA 12.0 software. Integrated Odd Ratio (OR) with its corresponding 95% confidence interval (95%CI) was calculated.
Results:
Six RCTs were included with a total of 547 patients with brain tumors. The meta-analysis results revealed that patients with brain tumors who received prophylactic antiepileptic interventions did not have significantly lower epilepsy incidence than those in controlled groups (OR=0.939, 95%CI=0.609-1.448, z=0.29, P=0.775). Sensitivity analysis suggested the statistical results were robust. No publication bias was detected in this meta-analysis (P>0.05).
Conclusion:
Although some past studies indicated AEDs can be used in patients with brain tumors to relieve epilepsy, present integrated evidences cannot show in unequivocal terms that brain tumor patients can benefit from seizure prophylaxis.
Insights
Prophylactic antiepileptic drugs (AEDs) do not significantly reduce seizure incidence in brain tumor patients without a prior seizure history. Current evidence does not unequivocally support routine seizure prophylaxis for this population.
Area of Science:
- Neuro-oncology
- Clinical Neurology
- Evidence-Based Medicine
Background:
- Seizures are a serious complication of brain tumors.
- Previous studies explored prophylactic antiepileptic drugs (AEDs) to reduce seizure incidence.
- Routine use of AEDs in seizure-naive brain tumor patients remains uncertain.
Purpose of the Study:
- To evaluate the effectiveness of seizure prophylaxis in brain tumor patients.
- To synthesize evidence from randomized trials on AEDs for seizure prevention.
Main Methods:
- A meta-analysis of six randomized controlled trials (RCTs) involving 547 patients.
- Comprehensive literature search across multiple databases (1966-2014).
- Meta-analysis performed using STATA 12.0, calculating Integrated Odd Ratio (OR) and 95% confidence intervals (95%CI).
Main Results:
- Prophylactic antiepileptic interventions did not significantly lower epilepsy incidence compared to control groups (OR=0.939, 95%CI=0.609-1.448).
- Statistical results were robust, with no detected publication bias.
- Analysis included six RCTs with a total of 547 participants.
Conclusions:
- Current integrated evidence does not unequivocally demonstrate benefit from seizure prophylaxis in brain tumor patients.
- Routine administration of AEDs for seizure prevention in this population is not supported by this meta-analysis.
- Further research may be needed to clarify the role of AEDs in brain tumor management.
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