Withdrawal of antiepileptic drugs in patients with low grade and anaplastic glioma after long-term seizure freedom: a prospective observational study

M Kerkhof,J C Reijneveld,M C M Kouwenhoven,M J Vos,J E C Bromberg,M J Van Den Bent,M J B Taphoorn,J A F Koekkoek,T J Postma,L Dirven,W Taal

doi:10.1007/s11060-019-03117-y

Abstract

BackgroundWhen glioma patients experience long-term seizure freedom the question arises whether antiepileptic drugs (AEDs) should be continued. As no prospective studies exist on seizure recurrence in glioma patients after AED withdrawal, we evaluated the decision-making process to withdraw AEDs in glioma patients, and seizure outcome after withdrawal.MethodsPatients with a histologically confirmed low grade or anaplastic glioma were included. Eligible patients were seizure free ≥ 1 year from the date of last antitumor treatment, or ≥ 2 years since the last seizure when seizures occurred after the end of the last antitumor treatment. Patients and neuro-oncologists made a shared decision on the preferred AED treatment (i.e. AED withdrawal or continuation). Primary outcomes were: (1) outcome of the shared decision-making process and (2) rate of seizure recurrence.ResultsEighty-three patients fulfilled all eligibility criteria. However, in 12/83 (14%) patients, the neuro-oncologist had serious objections to AED withdrawal. Therefore, 71/83 (86%) patients were analyzed; In 46/71 (65%) patients it was decided to withdraw AED treatment. In the withdrawal group, 26% (12/46) had seizure recurrence during follow-up. Seven of these 12 patients (58%) had tumor progression, of which three within 3 months after seizure recurrence. In the AED continuation group, 8% (2/25) of patients had seizure recurrence of which one had tumor progression.ConclusionIn 65% of patients a shared decision was made to withdraw AEDs, of which 26% had seizure recurrence. AED withdrawal should only be considered in carefully selected patients with a presumed low risk of tumor progression.

Highlights

Low grade gliomas are a group of primary brain tumors supposedly developing from supportive tissue cells, such as oligodendrocytes and astrocytes, or neural stem cells
Epilepsy in patients with glioma may be difficult to treat as 15–50% of patients do not become seizure free despite extensive treatment with antiepileptic drugs (AEDs) [3, 4]
Of the 71 patients approved for inclusion by the treating neuro-oncologist, a shared decision to withdraw AED(s) was made in 46 patients (65%) and to continue AED(s) in 25 patients (35%)

Summary

Introduction

Low grade gliomas are a group of primary brain tumors supposedly developing from supportive tissue cells, such as oligodendrocytes and astrocytes, or neural stem cells. Most patients with low grade glioma develop seizures during the course of their disease. Epilepsy in patients with glioma may be difficult to treat as 15–50% of patients do not become seizure free despite extensive treatment with antiepileptic drugs (AEDs) [3, 4]. Patients and neuro-oncologists made a shared decision on the preferred AED treatment (i.e. AED withdrawal or continuation). 26% (12/46) had seizure recurrence during follow-up Seven of these 12 patients (58%) had tumor progression, of which three within 3 months after seizure recurrence. In the AED continuation group, 8% (2/25) of patients had seizure recurrence of which one had tumor progression. Conclusion In 65% of patients a shared decision was made to withdraw AEDs, of which 26% had seizure recurrence. AED withdrawal should only be considered in carefully selected patients with a presumed low risk of tumor progression

Results

Discussion

Conclusion