Abstract
Purpose: Brain tumor-related epilepsy (BTRE) is a condition characterized by the development of seizures in the context of an undergoing oncological background. Levetiracetam (LEV) is a third-generation anti-seizure medication (ASM) widely used in BTRE prophylaxis. The study evaluated LEV neuropsychiatric side effects (SEs) in BTRE prophylaxis.Method: Twenty-eight patients with brain tumors were retrospectively selected and divided into two groups. In one group, we evaluated patients with a BTRE diagnosis using LEV (BTRE-group). The other group included patients with brain tumors who never had epilepsy and used a prophylactic ASM regimen with LEV (PROPHYLAXIS-group). Neuropsychiatric SEs of LEV were monitored using the Neuropsychiatric Inventory Questionnaire (NPI-Q) at the baseline visit and the 6- and 12-month follow-up.Results: Eighteen patients of the BTRE-group and 10 patients of the PROPHYLAXIS-group were included. Compared to the BTRE-group, the PROPHYLAXIS-group showed a higher severity of neuropsychiatric symptoms. According to Linear Mixed Models (LMM), a multiplicative effect was observed for the interaction between group treatment and time. For the caregiver distress score (CDS), only a time-effect was observed.Conclusion: Prophylactic ASM with LEV is associated with an increased frequency of neuropsychiatric SE. Accurate epileptological evaluations in patients with brain tumors are mandatory to select who would benefit most from ASM.
Highlights
Brain tumor-related epilepsy (BTRE) is one of the most frequent neurological manifestations in the context of brain tumors
This study evaluated the psychiatric tolerability of LEV when used in prophylactic treatment compared to treatment of patients suffering from BTRE
Patients were divided into two groups: patients with BTRE treated with LEV (BTRE-group) and patients without BTRE treated with LEV as prophylactic anti-seizure medications (ASM) (PROPHYLAXIS-group)
Summary
Brain tumor-related epilepsy (BTRE) is one of the most frequent neurological manifestations in the context of brain tumors. The prevalence of BTRE in patients with supratentorial brain tumors is up to 75%, with the highest percentage in cases of low-grade astrocytoma [2, 3]. The high prevalence of BTRE in patients suffering from brain tumors justifies the prophylactic use of ASM. The rationale for the procedure relates to the higher risk of developing BTRE, especially in association with brain surgery [5]. The use of ASM in patients with supratentorial brain tumors should consider [6] risk-benefits assessment. ASM prophylactic treatment is generally recommended during the perioperative period, starting from brain tumor diagnosis and prolonged from 1 week to more than 12 months after brain surgery [7]
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