Antiseizure medication choice in diffuse glioma: A single-center population-based experience

Several antiseizure medications (ASMs) can be considered as first-line treatment for glioma-associated epilepsy (GAE). We aimed to find out, if there are subgroups of glioma patients which may benefit from different first-line ASMs.

All diffuse glioma (grade 2-4) patients, who were in contact with Helsinki University Hospital Neurology or Oncology Departments during 2013-2015, were recognized from medical records. Follow-up data was retrospectively collected of all GAE patients living in Helsinki for 5 years from diagnosis of glioma, or until death.

A total of 121 patients with GAE fulfilling inclusion criteria were identified. Forty-nine (40.5%) had grade 2 glioma, 18 (14.9%) had grade 3 glioma, and 54 (44.6%) had grade 4 glioma. The most common first ASM was oxcarbazepine (39.2%), followed by levetiracetam (22.5%), carbamazepine (19.3%), phenytoin (10.8%) and valproic acid (8.3%). The first ASM was retained in use in 70 (57.9%) patients until the end of follow-up. Among patients with low-grade glioma, oxcarbazepine was favored, whereas grade 4 glioma patients more often received levetiracetam as first ASM. At the end of follow-up, the retention rate of levetiracetam as first ASM was higher than retention rate of other ASMs in grade 4 glioma patients (p 0.002). Patients who initiated valproic acid as first ASM underwent more ASM changes than patients who initiated other first-line ASM (p 0.005).

Levetiracetam seems to be a favorable first-line treatment for GAE, especially for patients with grade 4 glioma. For grade 2-3 glioma patients, oxcarbazepine may be a reasonable option.

Grade 2-4 gliomas are central nervous system tumors originating from glial cells, and epilepsy is common in glioma patients. We found that levetiracetam was favored as first antiseizure medication for patients with malignant, grade 4, glioma. For patients with slower-growing tumors, grade 2-3 gliomas, oxcarbazepine may be a reasonable choice for first antiseizure medication. The findings highlight the need for individual assessment in the use of antiseizure medications in glioma patients.