Antiepileptic drug usage in neuro-oncology: A practice survey

Abstract

Purpose: Despite the lack of high-quality evidence, anti-epileptic drugs (AEDs) are very commonly prescribed for seizure prophylaxis in patients with brain tumors even without prior history of seizures. We sought to review the current practices of prescribing AEDs among neuro-oncology health-care professionals. Materials and Methods: An e-mail with online link to a 15-item questionnaire regarding AED prophylaxis was sent to members of major academic societies representing the Indian Neuro-Oncology Community to assess the prevalent patterns of practice. Results: The online survey was completed by 318 of 3320 health-care professionals that were mailed for an overall response rate of 9.6%. Majority (68.9%) of respondents were radiation oncologists followed by neurosurgeons (22.9%) and medical oncologists/neurologists (8.2%). The practice setting spanned across the health-care spectrum, and over 75% reported having ≥ 5-year of experience in managing patients with brain tumors. Even for seizure-naive patients, 65.1% of respondents routinely prescribed prophylactic AEDs with significant variability in the duration of such prophylaxis. Levetiracetam was the most preferred AED (60%) followed by phenytoin (35%) in the survey. Most respondents believed that tumor type, histological grade, and anatomic location influenced the risk of seizures. Despite widespread use in clinical practice, only 27.3% of the respondents strongly believed that prophylactic AEDs significantly reduced the risk of seizures. Over 93% of respondents agreed that a large randomized controlled trial would better inform therapeutic decision-making regarding AED prophylaxis. Conclusions: This survey of the Indian Neuro-Oncology Community demonstrates widespread variability in the frequency and duration of AED prophylaxis in seizure-naive brain tumor patients in contemporary practice.