ANTI-SEIZURE MEDICATION IN GLIOMA PATIENTS: GETTING IT RIGHT fiRST TIME

Abstract

Abstract AIMS Seizures affect between 60–90% patients with low grade glioma and between 40–60% patients with high grade glioma. There are no national guidelines for seizure management in glioma patients. This quality improvement project investigated the initiation of anti-seizure medication in glioma patients with new-onset seizures. METHOD A retrospective review was undertaken of new glioma patients’ electronic notes (2020-2022) seen in Oncology clinic at Colchester hospital. RESULTS Thirty-seven patients (twenty-five glioblastoma IDH-wt, two grade 3 astrocytoma IDH-mutant, one grade 2 astrocytoma IDH-mutant, three oligodendroglioma IDH-mutant, six radiological diagnoses of glioma) were included. Following neurosurgical discharge, twenty-three did not need anti-seizure medication, three had long standing anti-seizure medication which was not changed, one patient was advised to stop phenytoin medication after surgery, four patients were on levetiracetam 500mg twice daily and six patients were on levetiracetam 250mg twice daily, with no dose escalation plan in place. Three of these six patients were subsequently hospitalised with seizures, one of which interrupted chemoradiation. None of the four patients on 500mg BD were hospitalised with seizures. CONCLUSIONS This project highlights the need for local anti-seizure guidelines for new glioma patients, which should include consideration of personalised drug choice, dependent on seizure type and demographics. Patients should be escalated to the therapeutic levetiracetam dose to decrease the risk of morbidity from seizures. This supports the need for national guidelines on anti-seizure medication with neurology collaboration.