Abstract
BACKGROUND: There is a lack of consensus in the use of newer-generation anti-epileptic drugs (AEDs) as prophylaxis in patients with malignant glioma (MG) who undergo surgical resection. The rate of seizure occurrence in MG is less than low-grade gliomas, but due to the debilitating nature of seizures, clinicians routinely prescribe prophylactic AEDs. Recommendations were last published in 2000 by the American Academy of Neurology based on research of older generation AEDs. Levetiracetam (LEV) is a newer generation AED with an improved safety profile and proven efficacy in heterogeneous patient populations, but its efficacy has yet to be determined in MG patients. METHODS: A retrospective analysis of AED usage was conducted among 114 patients diagnosed with MG (WHO Grade III-IV) who underwent initial resection at a single institution during 2011-2012. Demographics, comorbidities, tumor and surgical characteristics, AED usage, toxicity and seizure occurrence were reviewed. Seizure history was characterized prior to and up to 6 months after surgery. Logistic regression was used to evaluate the association of LEV prophylaxis and other risk factors with post-operative seizure occurrence. RESULTS: Patients were male (58%), had a gross total resection (88%), a history of seizures (44%), and received LEV pre-operatively (45%). Post-operatively, 91% received LEV of which 25% experienced a seizure. Side effects of LEV use were rare (n = 10, 10%), and included irritability, somnolence, psychiatric disturbances, and thrombocytopenia. Patient's age was a significant predictor of seizure occurrence. Older patients had a higher risk of seizure in the 6 months post-operatively (OR = 2.6, 95% CI 1.10-6.35, p = 0.0327). CONCLUSIONS: LEV is well tolerated in MG patients undergoing resection. Older age is associated with post-operative seizure occurrence. Future studies need to assess the effectiveness of LEV in reducing post-operative seizure recurrence in this population in comparison to other AEDs.
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