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Published on: October 27, 2014
Prophylactic anticonvulsants in patients with primary glioblastoma
Arvin R Wali1, Robert C Rennert1, Sonya G Wang2
1Department of Neurosurgery, University of California San Diego, La Jolla, CA, 92103, USA.
Abstract:
Glioblastoma is the most common form of primary brain cancer in adults and one of the deadliest of human cancers. Seizures are one of the most frequent presentations of glioblastoma. The use of anti-epileptic drugs (AEDs) in glioblastoma patients suffering from seizures is well accepted. However, the role of long-term AED use in patients with glioblastoma without a history of seizures is controversial. Here, we performed a review of the literature to identify studies that examined the use of AEDs in seizure-free glioblastoma patients. We identified one randomized controlled study suggesting no clinical benefit of seizure prophylaxis in this population. Three of the four retrospective studies identified in our search recapitulated this finding, while the remaining study suggested a benefit for prophylactic AED use. All identified studies were focused on seizure incidence in the post-operative period, ranging from 1 week to long-term follow up. Implications of these findings are reviewed herein.
Insights
For glioblastoma patients without seizures, prophylactic anti-epileptic drug (AED) use shows no clear clinical benefit. Most studies indicate AEDs do not prevent seizures in these individuals, questioning their routine use.
Area of Science:
- Neuro-oncology
- Clinical Neurology
Background:
- Glioblastoma is a highly aggressive primary brain cancer.
- Seizures are a common symptom in glioblastoma patients.
- The prophylactic use of anti-epileptic drugs (AEDs) in seizure-free glioblastoma patients is debated.
Purpose of the Study:
- To review existing literature on the efficacy of AEDs for seizure prophylaxis in glioblastoma patients who have not experienced seizures.
- To evaluate the clinical benefit of prophylactic AEDs in this specific patient population.
Main Methods:
- Literature review of studies investigating AED use in seizure-free glioblastoma patients.
- Analysis of one randomized controlled trial and four retrospective studies.
- Focus on seizure incidence in the post-operative period, with follow-up ranging from one week to long-term.
Main Results:
- One randomized controlled study found no clinical benefit from prophylactic AEDs.
- Three of four retrospective studies supported the finding of no benefit.
- One retrospective study suggested a potential benefit of prophylactic AED use.
Conclusions:
- The current evidence suggests limited to no clinical benefit of prophylactic anti-epileptic drug use in glioblastoma patients without a history of seizures.
- Further research may be needed to clarify the role of AEDs in specific post-operative scenarios or patient subgroups.
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