Abstract
Prescribing patterns amongst practising Australasian neurosurgeons regarding the use of prophylactic antiepileptic drugs (AEDs) in patients with newly diagnosed intrinsic brain tumours are not well established. This study aimed to determine the rate of prophylactic AED prescribing in this clinical context and to determine if there were some particular factors that influenced prescribers in their decision. A survey was conducted, and of the 91 respondents, 23 (25.3%) prescribed prophylactic AEDs. No neurosurgeons practising in New Zealand prescribed, whereas within Australian states/territories, prescribing was most common in Western Australia (3/4, 75.0%) and Queensland (8/18, 44.4%) and less common in the Australian Capital Territory (0/2, 0.0%) and South Australia (1/7, 14.3%). The most commonly prescribed first-line AED was phenytoin (n = 15, 68.2%) followed by levetiracetam (n = 5, 22.7%). The duration of prescription varied from 1 week to 6 months, with 6 weeks chosen by most prescribers (n = 7, 35%). Important factors that influence the decision to prescribe include tumour location and a history of previous seizure/s, whereas the presence of oedema or haemorrhage and patients’ age do not seem to be major influences amongst prescribers.
Highlights
IntroductionBoth primary and metastatic, are at an increased risk of experiencing seizures
Patients with brain tumours, both primary and metastatic, are at an increased risk of experiencing seizures
80 and 11 were neurosurgeons currently practising in Australia and New Zealand (NZ), respectively
Summary
Both primary and metastatic, are at an increased risk of experiencing seizures. A. Harding incidence of seizures amongst patients diagnosed with a brain tumour varies depending on certain factors, including tumour type and location. In a series of 1028 patients diagnosed with primary brain tumours, those with low-grade gliomas had a higher prevalence of epilepsy (85%) compared with patients with a diagnosis of glioblastoma (49%) [1]. Seizures are less common in metastases, reported in 24% in one series [2]. This is dependent on the type of metastasis, with melanoma seemingly the most epileptogenic (67%), reflective of a tendency to haemorrhage and to involve the cerebral cortex
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