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Liang S, Fan X, Chen F, Liu Y, Qiu B, Zhang K, Qi S, Zhang G, Liu J, Zhang J, Wang J, Wang X, Song Z, Luan G, Yang X, Jiang R, Zhang H, Wang L, You Y, Shu K, Lu X, Gao G, Zhang B, Zhou J, Jin H, Han K, Li Y, Wei J, Yang K, You G, Ji H, Jiang Y, Wang Y, Lin Z, Li Y, Liu X, Hu J, Zhu J, Li W, Wang Y, Kang D, Feng H, Liu T, Chen X, Pan Y, Liu Z, Li G, Li Y, Ge M, Fu X, Wang Y, Zhou D, Li S, Jiang T, Hou L, Hong Z. Chinese guideline on the application of anti-seizure medications in the perioperative period of supratentorial craniocerebral surgery. Ther Adv Neurol Disord 2022; 15:17562864221114357. [PMID: 35992894 PMCID: PMC9386849 DOI: 10.1177/17562864221114357] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022] Open
Abstract
Seizures are a common symptom of craniocerebral diseases, and epilepsy is one of the comorbidities of craniocerebral diseases. However, how to rationally use anti-seizure medications (ASMs) in the perioperative period of craniocerebral surgery to control or avoid seizures and reduce their associated harm is a problem. The China Association Against Epilepsy (CAAE) united with the Trauma Group of the Chinese Neurosurgery Society, Glioma Professional Committee of the Chinese Anti-Cancer Association, Neuro-Oncology Branch of the Chinese Neuroscience Society, and Neurotraumatic Group of Chinese Trauma Society, and selected experts for consultancy regarding outcomes from evidence-based medicine in domestic and foreign literature. These experts referred to the existing research evidence, drug characteristics, Chinese FDA-approved indications, and expert experience, and finished the current guideline on the application of ASMs during the perioperative period of craniocerebral surgery, aiming to guide relevant clinical practice. This guideline consists of six sections: application scope of guideline, concepts of craniocerebral surgery-related seizures and epilepsy, postoperative application of ASMs in patients without seizures before surgery, application of ASMs in patients with seizures associated with lesions before surgery, emergency treatment of postoperative seizures, and 16 recommendations.
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Affiliation(s)
- Shuli Liang
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing 100045, China
| | - Xing Fan
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Chen
- Xijing Hospital of Airforce Medical University, Xi'an, China
| | - Yonghong Liu
- Xijing Hospital of Airforce Medical University, Xi'an, China
| | - Binghui Qiu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kai Zhang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Songtao Qi
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guojun Zhang
- Xijing Hospital of Airforce Medical University, Xi'an, China
| | - Jinfang Liu
- Xiangya Hospital, Central South University, Changsha, China
| | - Jianguo Zhang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiu Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ziyang Song
- Xijing Hospital of Airforce Medical University, Xi'an, China
| | - Guoming Luan
- Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xuejun Yang
- Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Rongcai Jiang
- Tianjin Medical University General Hospital, Tianjin, China
| | - Hua Zhang
- Department of Neurosurgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Lei Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongping You
- Jiangsu Provincial People's Hospital, Nanjing, China
| | - Kai Shu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojie Lu
- The Affiliated Hospital, Jiangnan University, Wuxi, China
| | - Guoyi Gao
- Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bo Zhang
- Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Jian Zhou
- Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Hai Jin
- General Hospital of Northern Theater Command, Shenyang, China
| | - Kaiwei Han
- Shanghai Changzheng Hospital, Shanghai Neurosurgical Institute, Shanghai, China
| | - Yiming Li
- Shanghai Changzheng Hospital, Shanghai Neurosurgical Institute, Shanghai, China
| | - Junji Wei
- Peking Union Medical College Hospital, Beijing, China
| | - Kun Yang
- The First Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Gan You
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongming Ji
- Shanxi Provincial People's Hospital, Taiyuan, China
| | - Yuwu Jiang
- Peking University First Hospital, Beijing, China
| | - Yi Wang
- Children's Hospital of Fudan University, Shanghai, China
| | - Zhiguo Lin
- First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yan Li
- Children's Hospital of Soochow University, Suzhou, China
| | - Xuewu Liu
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China; Institute of Epilepsy, Shandong University, Jinan, China
| | - Jie Hu
- Huashan Hospital, Fudan University, Shanghai, China
| | - Junming Zhu
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Wenling Li
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yongxin Wang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Dezhi Kang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Hua Feng
- The Southwest Hospital, Army Medical University, Chongqing, China
| | - Tinghong Liu
- Xijing Hospital of Airforce Medical University, Xi'an, China
| | - Xin Chen
- Tianjin Medical University General Hospital, Tianjin, China
| | - Yawen Pan
- Lanzhou University Second Hospital, Lanzhou, China
| | - Zhixiong Liu
- Xiangya Hospital, Central South University, Changsha, China
| | - Gang Li
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yunqian Li
- The First Hospital of Jilin University, Changchun, China
| | - Ming Ge
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Key Laboratory of Major Disease in Children, Ministry of Education, Beijing, China
| | - Xianming Fu
- The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China
| | - Yuping Wang
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dong Zhou
- West China Hospital, Sichuan University, Chengdu, China
| | - Shichuo Li
- China Association Against Epilepsy, No. 135 Xizhimen Wai Avenue, Beijing 100044, China
| | - Tao Jiang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 10070, China
| | - Lijun Hou
- Shanghai Changzheng Hospital, Shanghai Neurosurgical Institute, No. 415, Fengyan Road, Huangpu District, Shanghai 200003, China
| | - Zhen Hong
- Huashan Hospital, Fudan University, No. 12, Urumqi Middle Road, Jing'an District, Shanghai 200044, China
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Daou BJ, Maher CO, Holste K, Palmateer G, Lint C, Elenbaas J, Thompson BG, Pandey AS. Seizure Prophylaxis in Unruptured Aneurysm Repair: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2020; 29:105171. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/26/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022] Open
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Monsour MA, Kelly PD, Chambless LB. Antiepileptic Drugs in the Management of Cerebral Metastases. Neurosurg Clin N Am 2020; 31:589-601. [PMID: 32921354 DOI: 10.1016/j.nec.2020.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Seizures represent a common and debilitating complication of central nervous system metastases. The use of prophylactic antiepileptic drugs (AEDs) in the preoperative period remains controversial, but the preponderance of evidence suggests that it is not helpful in preventing seizure and instead poses a significant risk of adverse events. Studies of postoperative seizure prophylaxis have not shown substantial benefit, but this practice remains widespread. Careful analysis of the risk of seizure based on patient-specific factors, such as tumor location and primary tumor histology, should guide the physician's decision on the initiation and cessation of prophylactic AED therapy.
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Affiliation(s)
- Meredith A Monsour
- Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN 37240-0002, USA
| | - Patrick D Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, T-4224 Medical Center North, Nashville, TN 37232-2380, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, T-4224 Medical Center North, Nashville, TN 37232-2380, USA.
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Greenhalgh J, Weston J, Dundar Y, Nevitt SJ, Marson AG. Antiepileptic drugs as prophylaxis for postcraniotomy seizures. Cochrane Database Syst Rev 2020; 4:CD007286. [PMID: 32343399 PMCID: PMC7195181 DOI: 10.1002/14651858.cd007286.pub5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This is an updated version of the Cochrane Review previously published in 2018. The incidence of seizures following supratentorial craniotomy for non-traumatic pathology has been estimated to be between 15% to 20%; however, the risk of experiencing a seizure appears to vary from 3% to 92% over a five-year period. Postoperative seizures can precipitate the development of epilepsy; seizures are most likely to occur within the first month of cranial surgery. The use of antiepileptic drugs (AEDs) administered pre- or postoperatively to prevent seizures following cranial surgery has been investigated in a number of randomised controlled trials (RCTs). OBJECTIVES To determine the efficacy and safety of AEDs when used prophylactically in people undergoing craniotomy and to examine which AEDs are most effective. SEARCH METHODS For the latest update we searched the following databases on 29 September 2019: Cochrane Epilepsy Group Specialized Register, CENTRAL, MEDLINE, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP). We did not apply any language restrictions. SELECTION CRITERIA We included RCTs of people with no history of epilepsy who were undergoing craniotomy for either therapeutic or diagnostic reasons. We included trials with adequate randomisation methods and concealment; these could either be blinded or unblinded parallel trials. We did not stipulate a minimum treatment period, and we included trials using active drugs or placebo as a control group. DATA COLLECTION AND ANALYSIS Three review authors (JW, JG, YD) independently selected trials for inclusion, extracted data and assessed risk of bias. We resolved any disagreements through discussion. Outcomes investigated included the number of participants experiencing seizures (early (occurring within first week following craniotomy), and late (occurring after first week following craniotomy)), the number of deaths and the number of people experiencing disability and adverse effects. Due to the heterogeneous nature of the trials, we did not combine data from the included trials in a meta-analysis; we presented the findings of the review in narrative format. Visual comparisons of outcomes are presented in forest plots. MAIN RESULTS We included 10 RCTs (N = 1815), which were published between 1983 and 2015. Three trials compared a single AED (phenytoin) with placebo or no treatment. One, three-armed trial compared two AEDs (phenytoin, carbamazepine) with no treatment. A second three-armed trial compared phenytoin, phenobarbital with no treatment. Of these five trials comparing AEDs with placebo or no treatment, two trials reported a statistically significant advantage for AED treatment compared to controls for early seizure occurrence; all other comparisons showed no clear or statistically significant differences between AEDs and control treatment. None of the trials that were head-to-head comparisons of AEDs (phenytoin versus sodium valproate, phenytoin versus phenobarbital, levetiracetam versus phenytoin, zonisamide versus phenobarbital) reported any statistically significant differences between treatments for either early or late seizure occurrence. Only five trials reported incidences of death. One trial reported statistically significantly fewer deaths in the carbamazepine and no-treatment groups compared with the phenytoin group after 24 months of treatment, but not after six months of treatment. Incidences of adverse effects of treatment were poorly reported; however, three trials did show that significantly more adverse events occurred on phenytoin compared to valproate, placebo, or no treatment. No trials reported any results relating to functional outcomes such as disability. We considered the evidence to be of low certainty for all reported outcomes due to methodological issues and variability of comparisons made in the trials. AUTHORS' CONCLUSIONS There is limited, low-certainly evidence to suggest that AED treatment administered prophylactically is either effective or not effective in the prevention of postcraniotomy (early or late) seizures. The current evidence base is limited due to the different methodologies employed in the trials and inconsistencies in the reporting of outcomes including deaths and adverse events. Further evidence from good-quality, contemporary trials is required in order to assess the clinical effectiveness of prophylactic AED treatment compared to placebo or no treatment, or other AEDs in preventing postcraniotomy seizures in this select group of patients.
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Affiliation(s)
- Janette Greenhalgh
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Jennifer Weston
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Yenal Dundar
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
- Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Sarah J Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Liverpool Health Partners, Liverpool, UK
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Goldschmidt E, Chabot JD, Algattas H, Lieber S, Khattar N, Nakassa ACI, Angriman F, Snyderman CH, Wang EW, Fernandez-Miranda JC, Gardner PA. Seizure Risk following Open and Expanded Endoscopic Endonasal Approaches for Intradural Skull Base Tumors. J Neurol Surg B Skull Base 2019; 81:673-679. [PMID: 33381372 DOI: 10.1055/s-0039-1694968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/03/2019] [Indexed: 12/14/2022] Open
Abstract
Objectives The incidence of seizures following a craniotomy for tumor removal varies between 15 and 20%. There has been increased use of endoscopic endonasal approaches (EEAs) for a variety of intracranial lesions due to its more direct approach to these pathologies. However, the incidence of postoperative seizures in this population is not well described. Methods This is a single-center, retrospective review of consecutive patients undergoing EEA or open craniotomy for resection of a cranial base tumor between July 2007 and June 2014. Patients were included if they underwent an EEA for an intradural skull base lesion. Positive cases were defined by electroencephalograms and clinical findings. Patients who underwent a craniotomy to remove extra-axial skull base tumors were analyzed in the same fashion. Results Of the 577 patients treated with an EEA for intradural tumors, 4 experienced a postoperative seizure (incidence 0.7%, 95% confidence interval [CI]: 0.002-0.02). Over the same period, 481 patients underwent a craniotomy for a skull base lesion of which 27 (5.3%, 95% CI: 0.03-0.08) experienced a seizure after surgery. The odds ratio for EEA was 0.13 (95% CI: 0.05-0.35). Both populations were different in terms of age, gender, tumor histology, and location. Conclusion This study is the largest series looking at seizure incidence after EEA for intracranial lesions. Seizures are a rare occurrence following uncomplicated endonasal approaches. This must be tempered by selection bias, as there are inherent differences in which patients are treated with either approach that influence the likelihood of seizures.
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Affiliation(s)
- Ezequiel Goldschmidt
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Joseph D Chabot
- Department of Neurosciences, Centracare Clinic, St. Cloud Hospital, St. Cloud, Minneapolis, United States
| | - Hanna Algattas
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Stefan Lieber
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Nicholas Khattar
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, United States
| | - Ana C I Nakassa
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Federico Angriman
- Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Carl H Snyderman
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric W Wang
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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Liang S, Fan X, Zhao M, Shan X, Li W, Ding P, You G, Hong Z, Yang X, Luan G, Ma W, Yang H, You Y, Yang T, Li L, Liao W, Wang L, Wu X, Yu X, Zhang J, Mao Q, Wang Y, Li W, Wang X, Jiang C, Liu X, Qi S, Liu X, Qu Y, Xu J, Wang W, Song Z, Wu J, Liu Z, Chen L, Lin Y, Zhou J, Liu X, Zhang W, Li S, Jiang T. Clinical practice guidelines for the diagnosis and treatment of adult diffuse glioma-related epilepsy. Cancer Med 2019; 8:4527-4535. [PMID: 31240876 PMCID: PMC6712518 DOI: 10.1002/cam4.2362] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 05/05/2019] [Accepted: 05/25/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Glioma-related epilepsy (GRE) is defined as symptomatic epileptic seizures secondary to gliomas, it brings both heavy financial and psychosocial burdens to patients with diffuse glioma and significantly decreases their quality of life. To date, there have been no clinical guidelines that provide recommendations for the optimal diagnostic and therapeutic procedures for GRE patients. METHODS In March 2017, the Joint Task Force for GRE of China Association Against Epilepsy and Society for Neuro-Oncology of China launched the guideline committee for the diagnosis and treatment of GRE. The guideline committee conducted a comprehensive review of relevant domestic and international literatures that were evaluated and graded based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence, and then held three consensus meetings to discuss relevant recommendations. The recommendations were eventually given according to those relevant literatures, together with the experiences in the diagnosis and treatment of over 3000 GRE cases from 24 tertiary level hospitals that specialize in clinical research of epilepsy, glioma, and GRE in China. RESULTS The manuscript presented the current standard recommendations for the diagnostic and therapeutic procedures of GRE. CONCLUSIONS The current work will provide a framework and assurance for the diagnosis and treatment strategy of GRE to reduce complications and costs caused by unnecessary treatment. Additionally, it can serve as a reference for all professionals involved in the management of patients with GRE.
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Affiliation(s)
- Shuli Liang
- Department of Neurosurgery, Chinese PLA General Hospital and PLA Medical College, Beijing, China.,Department of Functional Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xing Fan
- Department of Neuroelectrophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Zhao
- Department of Neurosurgery, First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Xia Shan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Molecular Neuropathology, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
| | - Wenling Li
- Department of Neurosurgery, Second Affiliated Hospital, Hebei Medical University, Shijiazhuang, China
| | - Ping Ding
- Department of Neurosurgery, Chinese PLA General Hospital and PLA Medical College, Beijing, China
| | - Gan You
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhen Hong
- Department of Neurology, Shanghai Huashan Hospital, Fudan University, Shaihai, China
| | - Xuejun Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Guoming Luan
- Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Yang
- Department of Neurosurgery, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yongpin You
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tianming Yang
- Department of Neurosurgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Liang Li
- Department of Neurosurgery, First Affiliated Hospital, Beijing University, Beijing, China
| | - Weiping Liao
- Department of Neurology, Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lei Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xun Wu
- Department of Neurology, First Affiliated Hospital, Beijing University, Beijing, China
| | - Xinguang Yu
- Department of Neurosurgery, Chinese PLA General Hospital and PLA Medical College, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qing Mao
- Department of Neurosurgery, Huaxi Hospital, Sichuan University, Chengdu, China
| | - Yuping Wang
- Department of Neurology, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbin Li
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xuefeng Wang
- Department of Neurology, First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Chuanlu Jiang
- Department of Neurosurgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaoyan Liu
- Pediatric Department, First Affiliated Hospital, Beijing University, Beijing, China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Nanfang Medical University, Guangzhou, China
| | - Xingzhou Liu
- Epilepsy Center, Shanghai Deji Hospital, Shanghai, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jiwen Xu
- Department of Functional Neurosurgery, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weimin Wang
- Department of Neurosurgery, Guangzhou Military General Hospital, Guangzhou, China
| | - Zhi Song
- Department of Neurology, Xiangya Third Hospital, Center South University, Changsha, China
| | - Jinsong Wu
- Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University, Shanghai, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China
| | - Ling Chen
- Department of Neurosurgery, Chinese PLA General Hospital and PLA Medical College, Beijing, China
| | - Yuanxiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jian Zhou
- Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China
| | - Xianzeng Liu
- Department of Neurology, Peking University International Hospital, Beijing, China
| | - Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Molecular Neuropathology, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
| | - Shichuo Li
- China Association Against Epilepsy (CAAE), Beijing, China
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Molecular Neuropathology, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
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Lee CH, Koo HW, Han SR, Choi CY, Sohn MJ, Lee CH. Phenytoin versus levetiracetam as prophylaxis for postcraniotomy seizure in patients with no history of seizures: systematic review and meta-analysis. J Neurosurg 2019; 130:2063-2070. [PMID: 30004278 DOI: 10.3171/2018.4.jns1891] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/05/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVEDe novo seizure following craniotomy (DSC) for nontraumatic pathology may adversely affect medical and neurological outcomes in patients with no history of seizures who have undergone craniotomies. Antiepileptic drugs (AEDs) are commonly used prophylactically in patients undergoing craniotomy; however, evidence supporting this practice is limited and mixed. The authors aimed to collate the available evidence on the efficacy and tolerability of levetiracetam monotherapy and compare it with that of the classic AED, phenytoin, for DSC.METHODSPubMed, Embase, Web of Science, and the Cochrane Library were searched for studies that compared levetiracetam with phenytoin for DSC prevention. Inclusion criteria were adult patients with no history of epilepsy who underwent craniotomy with prophylactic usage of phenytoin, a comparator group with levetiracetam treatment as the main treatment difference between the two groups, and availability of data on the numbers of patients and seizures for each group. Patients with brain injury and previous seizure history were excluded. DSC occurrence and adverse drug reaction (ADR) were evaluated. Seizure occurrence was calculated using the Peto odds ratio (POR), which is the relative effect estimation method of choice for binary data with rare events.RESULTSData from 7 studies involving 803 patients were included. The DSC occurrence rate was 1.26% (4/318) in the levetiracetam cohort and 6.60% (32/485) in the phenytoin cohort. Meta-analysis showed that levetiracetam is significantly superior to phenytoin for DSC prevention (POR 0.233, 95% confidence interval [CI] 0.117-0.462, p < 0.001). Subgroup analysis demonstrated that levetiracetam is superior to phenytoin for DSC due to all brain diseases (POR 0.129, 95% CI 0.039-0.423, p = 0.001) and tumor (POR 0.282, 95% CI 0.117-0.678, p = 0.005). ADRs in the levetiracetam group were cognitive disturbance, thrombophlebitis, irritability, lethargy, tiredness, and asthenia, whereas rash, anaphylaxis, arrhythmia, and hyponatremia were more common in the phenytoin group. The overall occurrence of ADR in the phenytoin (34/466) and levetiracetam (26/432) groups (p = 0.44) demonstrated no statistically significant difference in ADR occurrence. However, the discontinuation rate of AEDs due to ADR was 53/297 in the phenytoin group and 6/196 in the levetiracetam group (POR 0.266, 95% CI 0.137-0.518, p < 0.001).CONCLUSIONSLevetiracetam is superior to phenytoin for DSC prevention for nontraumatic pathology and has fewer serious ADRs that lead to discontinuation. Further high-quality studies that compare levetiracetam with placebo are necessary to provide evidence for establishing AED guidelines.
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Affiliation(s)
- Chang-Hyun Lee
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul
| | - Hae-Won Koo
- 3Department of Neurosurgery, Neuroscience & Radiosurgery Hybrid Research Center, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Seong Rok Han
- 2Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine; and
| | - Chan-Young Choi
- 2Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine; and
| | - Moon-Jun Sohn
- 3Department of Neurosurgery, Neuroscience & Radiosurgery Hybrid Research Center, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Chae-Heuck Lee
- 2Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine; and
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Prophylactic antiepileptic treatment with levetiracetam for patients undergoing supratentorial brain tumor surgery: a two-center matched cohort study. Neurosurg Rev 2019; 43:709-718. [PMID: 31098789 DOI: 10.1007/s10143-019-01111-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/12/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
Guidelines on the administration of prophylactic antiepileptic drugs (AED), and specifically levetiracetam, for brain tumor surgery are still lacking. In this two-center matched cohort study, we aim to compare the proportion of postoperative seizures during follow-up after supratentorial tumor surgery in patients receiving no seizure prophylaxis, and those treated with levetiracetam perioperatively. Three hundred sixteen consecutive patients undergoing supratentorial tumor surgery, without history of seizures were included: 207 patients did not receive AED (no AED group), and 109 patients received levetiracetam perioperatively (levetiracetam group). The primary outcome measure was the rate of postoperative seizures. Additionally, uni- and multivariate analyses assessing possible risk factors for postoperative seizures were performed. No statistically significant difference for the occurrence of postoperative seizures was found between the two groups (10.1%, n = 21 in the no AED group vs. 9.2%, n = 10, in the levetiracetam group; p = 0.69, OR 0.9 [0.4-2.0), NNT 103 [12.9-17.1]). After propensity score matching, the primary outcome was observed in 13 patients (12.4%) from the no AED group and in 9 patients (8.6%) from the levetiracetam group (p = 0.50, OR 0.7 [0.3-1.6], NNT 26.3 [8.3-22.4]). Among all analyzed possible risk factors for postoperative seizures, only postoperative infarction showed a statistically significant association with higher seizure rates in multivariate analysis (OR 8.2 [1.1-60.6], p = 0.04). Prophylactic treatment with levetiracetam after brain tumor surgery showed no statistically significant effect in preventing postoperative seizures. However, in case a postoperative infarction occurs, its administration might be indicated.
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Islim AI, Ali A, Bagchi A, Ahmad MU, Mills SJ, Chavredakis E, Brodbelt AR, Jenkinson MD. Postoperative seizures in meningioma patients: improving patient selection for antiepileptic drug therapy. J Neurooncol 2018; 140:123-134. [PMID: 29959695 PMCID: PMC6182382 DOI: 10.1007/s11060-018-2941-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/25/2018] [Indexed: 11/30/2022]
Abstract
Background Epilepsy is a major cause of morbidity and mortality in meningioma patients. The aims of this study were to determine which factors predispose meningioma patients to developing perioperative seizures and to understand the impact of antiepileptic drugs. Methods Patients treated for a histologically-confirmed intracranial meningioma at the authors’ institution between 2010 and 2015 were retrospectively examined. Clinical and imaging data were assessed. Multivariate analysis was performed using binary logistic regression. The effect of antiepileptic treatment was assessed using survival analysis. Results Two hundred and eighty-three patients met the selection criteria; seizures were present in 68 preoperatively (24%) and in 48 patients (17%) following surgery. Of the 68 with preoperative seizures, 19 continued to have them, whereas de-novo seizures arose postoperatively in 29 seizure-naïve patients. Risk factors of postoperative seizures were convexity location (OR 2.05 [95% CI 1.07–3.98], p = 0.030), fronto-parietal location (OR 4.42 [95% CI 1.49–13.16], p = 0.007) and preoperative seizures (OR 2.65 [95% CI 1.37–5.24], p = 0.005). The two locations, in addition to the presence of midline shift on preoperative imaging (OR 4.15 [95% CI 1.54–11.24], p = 0.005), were significantly correlated with postoperative seizures in seizure-naïve patients. Antiepileptic treatment in patients with those risk factors reduced the possibility of seizures at any time point within the 1st year postoperatively by approximately 40%, although this did not meet statistical significance. Conclusion Prophylactic antiepileptic treatment might be warranted in seizure-naïve meningioma patients with ≥ 1 risk factor. High-quality randomised controlled trials are required to verify those factors and to define the role of antiepileptics in meningioma practice.
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Affiliation(s)
- Abdurrahman I Islim
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK. .,School of Medicine, University of Liverpool, Liverpool, UK. .,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | - Arousa Ali
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Ananyo Bagchi
- School of Medicine, University of Liverpool, Liverpool, UK.,Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | | | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Emmanuel Chavredakis
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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10
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Franchino F, Rudà R, Soffietti R. Mechanisms and Therapy for Cancer Metastasis to the Brain. Front Oncol 2018; 8:161. [PMID: 29881714 PMCID: PMC5976742 DOI: 10.3389/fonc.2018.00161] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/30/2018] [Indexed: 12/12/2022] Open
Abstract
Advances in chemotherapy and targeted therapies have improved survival in cancer patients with an increase of the incidence of newly diagnosed brain metastases (BMs). Intracranial metastases are symptomatic in 60–70% of patients. Magnetic resonance imaging (MRI) with gadolinium is more sensitive than computed tomography and advanced neuroimaging techniques have been increasingly used in the detection, treatment planning, and follow-up of BM. Apart from the morphological analysis, the most effective tool for characterizing BM is immunohistochemistry. Molecular alterations not always reflect those of the primary tumor. More sophisticated methods of tumor analysis detecting circulating biomarkers in fluids (liquid biopsy), including circulating DNA, circulating tumor cells, and extracellular vesicles, containing tumor DNA and macromolecules (microRNA), have shown promise regarding tumor treatment response and progression. The choice of therapeutic approaches is guided by prognostic scores (Recursive Partitioning Analysis and diagnostic-specific Graded Prognostic Assessment-DS-GPA). The survival benefit of surgical resection seems limited to the subgroup of patients with controlled systemic disease and good performance status. Leptomeningeal disease (LMD) can be a complication, especially in posterior fossa metastases undergoing a “piecemeal” resection. Radiosurgery of the resection cavity may offer comparable survival and local control as postoperative whole-brain radiotherapy (WBRT). WBRT alone is now the treatment of choice only for patients with single or multiple BMs not amenable to surgery or radiosurgery, or with poor prognostic factors. To reduce the neurocognitive sequelae of WBRT intensity modulated radiotherapy with hippocampal sparing, and pharmacological approaches (memantine and donepezil) have been investigated. In the last decade, a multitude of molecular abnormalities have been discovered. Approximately 33% of patients with non-small cell lung cancer (NSCLC) tumors and epidermal growth factor receptor mutations develop BMs, which are targetable with different generations of tyrosine kinase inhibitors (TKIs: gefitinib, erlotinib, afatinib, icotinib, and osimertinib). Other “druggable” alterations seen in up to 5% of NSCLC patients are the rearrangements of the “anaplastic lymphoma kinase” gene TKI (crizotinib, ceritinib, alectinib, brigatinib, and lorlatinib). In human epidermal growth factor receptor 2-positive, breast cancer targeted therapies have been widely used (trastuzumab, trastuzumab-emtansine, lapatinib-capecitabine, and neratinib). Novel targeted and immunotherapeutic agents have also revolutionized the systemic management of melanoma (ipilimumab, nivolumab, pembrolizumab, and BRAF inhibitors dabrafenib and vemurafenib).
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Affiliation(s)
- Federica Franchino
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
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11
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Greenhalgh J, Weston J, Dundar Y, Nevitt SJ, Marson AG. Antiepileptic drugs as prophylaxis for postcraniotomy seizures. Cochrane Database Syst Rev 2018; 5:CD007286. [PMID: 29791030 PMCID: PMC6494638 DOI: 10.1002/14651858.cd007286.pub4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This is an updated version of the Cochrane Review previously published in Issue 3, 2015.The incidence of seizures following supratentorial craniotomy for non-traumatic pathology has been estimated to be between 15% to 20%; however, the risk of experiencing a seizure appears to vary from 3% to 92% over a five-year period. Postoperative seizures can precipitate the development of epilepsy; seizures are most likely to occur within the first month of cranial surgery. The use of antiepileptic drugs (AEDs) administered pre- or postoperatively to prevent seizures following cranial surgery has been investigated in a number of randomised controlled trials (RCTs). OBJECTIVES To determine the efficacy and safety of AEDs when used prophylactically in people undergoing craniotomy and to examine which AEDs are most effective. SEARCH METHODS For the latest update we searched the following databases on 26 June 2017: Cochrane Epilepsy Group Specialized Register, the CENTRAL, MEDLINE, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP). We did not apply any language restrictions. SELECTION CRITERIA We included RCTs of people with no history of epilepsy who were undergoing craniotomy for either therapeutic or diagnostic reasons. We included trials with adequate randomisation methods and concealment; these could either be blinded or unblinded parallel trials. We did not stipulate a minimum treatment period, and we included trials using active drugs or placebo as a control group. DATA COLLECTION AND ANALYSIS Three review authors (JW, JG, YD) independently selected trials for inclusion and performed data extraction and risk of bias assessments. We resolved any disagreements through discussion. Outcomes investigated included the number of participants experiencing seizures (early (occurring within first week following craniotomy), and late (occurring after first week following craniotomy)), the number of deaths and the number of people experiencing disability and adverse effects. Due to the heterogeneous nature of the trials, we did not combine data from the included trials in a meta-analysis; we presented the findings of the review in narrative format. Visual comparisons of outcomes are presented in forest plots. MAIN RESULTS We included 10 RCTs (N = 1815), which were published between 1983 and 2015. Three trials compared a single AED (phenytoin) with placebo or no treatment. One three-armed trial compared two AEDs (phenytoin, carbamazepine) with no treatment. A second three-armed trial compared phenytoin, phenobarbital with no treatment. Of these five trials comparing AEDs with placebo or no treatment, two trials reported a statistically significant advantage for AED treatment compared to controls for early seizure occurrence; all other comparisons showed no clear or statistically significant differences between AEDs and control treatment. None of the trials that were head-to-head comparisons of AEDs (phenytoin versus sodium valproate, phenytoin versus phenobarbital, levetiracetam versus phenytoin, zonisamide versus phenobarbital) reported any statistically significant differences between treatments for either early or late seizure occurrence.Incidences of death were reported in only five trials. One trial reported statistically significantly fewer deaths in the carbamazepine and no-treatment groups compared with the phenytoin group after 24 months of treatment, but not after six months of treatment. Incidences of adverse effects of treatment were poorly reported; however, three trials did show that significantly more adverse events occurred on phenytoin compared to valproate, placebo, or no treatment. No trials reported any results relating to functional outcomes such as disability.We considered the evidence to be of low quality for all reported outcomes due to methodological issues and variability of comparisons made in the trials. AUTHORS' CONCLUSIONS There is limited, low-quality evidence to suggest that AED treatment administered prophylactically is either effective or not effective in the prevention of postcraniotomy (early or late) seizures. The current evidence base is limited due to the different methodologies employed in the trials and inconsistencies in the reporting of outcomes including deaths and adverse events. Further evidence from good-quality, contemporary trials is required in order to assess the clinical effectiveness of prophylactic AED treatment compared to placebo or no treatment, or other AEDs in preventing postcraniotomy seizures in this select group of patients.
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Affiliation(s)
- Janette Greenhalgh
- University of LiverpoolLiverpool Reviews and Implementation GroupSherrington BuildingAshton StreetLiverpoolUKL69 3GE
| | - Jennifer Weston
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneFazakerleyLiverpoolMerseysideUKL9 7LJ
| | - Yenal Dundar
- University of LiverpoolLiverpool Reviews and Implementation GroupSherrington BuildingAshton StreetLiverpoolUKL69 3GE
- Mersey Care NHS Foundation TrustHesketh CentreLiverpoolMerseysideUK
| | - Sarah J Nevitt
- University of LiverpoolDepartment of BiostatisticsBlock F, Waterhouse Building1‐5 Brownlow HillLiverpoolUKL69 3GL
| | - Anthony G Marson
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneFazakerleyLiverpoolMerseysideUKL9 7LJ
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12
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Eshra MA. Endoscopic management of third ventricular colloid cysts in mildly dilated lateral ventricles. Neurosurg Rev 2018. [PMID: 29527620 DOI: 10.1007/s10143-018-0956-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Colloid cysts of the third ventricle are considered as benign lesions. The clinical manifestations are not clear in most of cases. Many treatment options are available and endoscopic removal of the cysts proves to be a very successful method especially if the lateral ventricles are moderately or severely dilated. Sometimes, we faced cases with non- or mildly dilated ventricles which may add more risks to the operation, limit the radicality of removal, or abort the procedure entirely. Sixteen cases of colloid cyst with mildly dilated ventricles were operated upon between 2008 and 2016 using the rigid endoscopic system. Twelve were female and four were male. Their ages were between 17 and 40 years old. Headaches and epileptic fits were the presenting symptoms in 13 cases and 2 cases respectively. One case was asymptomatic. The patients were followed up from 1 to 4 years. Total removal in 12 cases and evacuation of the contents and partial removal in 4 cases. Mild transient complications occurred in the form of fever in seven cases, vomiting in four cases or short-term recent memory loss in three cases. No deaths occurred due to the procedures. Working endoscopically in enlarged ventricles is very effective and easy; however, small sized ventricles do not prevent safe and effective complete removal of colloid cysts. Cases with residual cyst wall do not suffer from recurrence.
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Affiliation(s)
- Mohamed A Eshra
- Department of neurosurgery, Faculty of Medicine, Alexandria University, Champillion St., Elazaritta, Alexandria, Egypt.
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13
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Levetiracetam versus phenytoin for seizure prophylaxis in brain injured patients: a systematic review and meta-analysis. Int J Clin Pharm 2017; 39:998-1003. [PMID: 28780739 DOI: 10.1007/s11096-017-0507-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/07/2017] [Indexed: 10/19/2022]
Abstract
Background The onset of early and/or late seizures in brain injured patients is associated with worse outcome. So far, phenytoin is the most commonly used antiepileptic drug to prevent seizures in this group of patients. Objective In the current metaanalysis, we aimed to compare the efficacy and safety of phenytoin versus levetiracetam for seizure prophylaxis in brain injured patients. Methods A systematic search was conducted in PubMed and Cochrane Library Database by 2 investigators. Four randomized controlled trials (RCTs) were included (295 patients). Data were extracted and the quality of each RCT was assessed. Results Levetiracetam was found to be more effective than phenytoin in seizure prophylaxis (OR = 0.23; CI 95% [0.09-0.56]; Q test p value = 0.18 and I2 = 38%). A trend toward less serious side effects was also found in patients treated with levetiracetam (OR = 0.27; CI 95% [0.07-1.07]; Q test p value = 0.72 and I2 = 0%). Conclusion Levetiracetam is more effective and safer than phenytoin for seizure prophylaxis in brain injured patients.
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14
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Connolly ID, Johnson E, Lamsam L, Veeravagu A, Ratliff J, Li G. Microsurgical vs. Endoscopic Excision of Colloid Cysts: An Analysis of Complications and Costs Using a Longitudinal Administrative Database. Front Neurol 2017; 8:259. [PMID: 28649225 PMCID: PMC5465269 DOI: 10.3389/fneur.2017.00259] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/22/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Open microsurgical and endoscopic approaches are the two main surgical options for excision of colloid cysts. Controversy remains as to which is superior. Previous studies consist of small cohort sizes. This topic has not been investigated using national administrative claims data which benefits from larger patient numbers. METHODS Current Procedural Terminology (CPT) and International Classification of Disease version 9 (ICD-9) coding at inpatient visit was used to select for index surgical procedures corresponding to microsurgical or endoscopic excision of colloid cysts. Comorbidities, costs, and complications were collected. RESULTS We identified a total of 483 patients. In all, 240 were from the microsurgical cohort and 243 were from the endoscopic cohort. The two groups displayed similar demographic and comorbidity profiles. Thirty-day post-operative complications were also similar between groups with the exception of seizures and thirty-day readmissions, both higher in the open surgical cohort. The seizure rates were 14.7 and 5.4% in the microsurgical and endoscopic cohorts, respectively (p = 0.0011). The thirty-day readmission rates were 17.3 and 9.6% in the microsurgical and endoscopic cohorts, respectively (p = 0.0149). Index admission costs and 90-day post discharge payments were higher in patients receiving microsurgical excision. CONCLUSION An analysis of administrative claims data revealed few differences in surgical complications following colloid cyst excision via microsurgical and endoscopic approaches. Post-operative seizures and thirty-day readmissions were seen at higher frequency in patients who underwent microsurgical resection. Despite similar complication profiles, patients undergoing microsurgical excision experienced higher index admission costs and 90-day aggregated costs suggesting that complications may have been more severe in this group.
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Affiliation(s)
- Ian David Connolly
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Eli Johnson
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Layton Lamsam
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - John Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Gordon Li
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
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15
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Riblet NB, Schlosser EM, Snide JA, Ronan L, Thorley K, Davis M, Hong J, Mason LP, Cooney TJ, Jalowiec L, Kennedy NL, Richie S, Nalepinski D, Fadul CE. A clinical care pathway to improve the acute care of patients with glioma. Neurooncol Pract 2016; 3:145-153. [PMID: 31386082 PMCID: PMC6668280 DOI: 10.1093/nop/npv050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients with glioma are at increased risk for tumor-related and treatment-related complications. Few guidelines exist to manage complications through supportive care. Our prior work suggests that a clinical care pathway can improve the care of patients with glioma. METHODS We designed a quality improvement (QI) project to address the acute care needs of patients with gliomas. We formed a multidisciplinary team and selected 20 best-practice measures from the literature. Using a plan-do-study-act framework, we brainstormed and implemented various improvement strategies starting in October 2013. Statistical process control charts were used to assess progress. RESULTS Retrospective data were available for 12 best practice measures. The baseline population consisted of 98 patients with glioma. Record review suggested wide variation in performance, with compliance ranging from 30% to 100%. The team hypothesized that lack of process standardization may contribute to less-than-ideal performance. After implementing improvement strategies, we reviewed the records of 63 consecutive patients with glioma. The proportion of patients meeting criteria for 12 practice measures modestly improved (65% pre-QI; 76% post-QI, P > .1). Unexpectedly, a higher proportion of patients were readmitted within 30 days of hospital discharge (pre-QI: 10%; post-QI: 17%, P > .1). Barriers to pathway development included difficulties with transforming manual measures into electronic data sets. CONCLUSIONS Creating evidence-based clinical care pathways for addressing the acute care needs of patients with glioma is feasible and important. There are many challenges, however, to developing sustainable systems for measuring and reporting performance outcomes overtime.
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Affiliation(s)
- Natalie B.V. Riblet
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
| | - Evelyn M. Schlosser
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
| | - Jennifer A. Snide
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
| | - Lara Ronan
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
| | - Katherine Thorley
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
| | - Melissa Davis
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
| | - Jennifer Hong
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
| | - Linda P. Mason
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
| | - Tobi J. Cooney
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
| | - Lanelle Jalowiec
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
| | - Nancy L. Kennedy
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
| | - Sabrina Richie
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
| | - David Nalepinski
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
| | - Camilo E. Fadul
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive,
Lebanon, NH 03756 (E.M.S., J.A.S., L.R., K.T.,
M.D., J.H., L.P.M., T.J.C., L.J., N.L.K., S.R., D.N., C.E.F.); Norris Cotton
Cancer Center, 1 Medical Center Drive, Lebanon,
NH 03756 (M.D., J.S., L.R., L.M., L.J., S.R., D.N., C.F.);
Geisel School of Medicine at Dartmouth, 1 Rope Ferry
Drive, Hanover, NH 03755 (N.B.V.R., L.R., C.F.); VA Medical Center,
215 North Main Street, White River Junction VT 05009 (N.B.V.R.)
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16
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Perucca E, Wiebe S. Not all that glitters is gold: A guide to the critical interpretation of drug trials in epilepsy. Epilepsia Open 2016; 1:9-21. [PMID: 29588925 PMCID: PMC5867835 DOI: 10.1002/epi4.3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 01/10/2023] Open
Abstract
Clinical trials represent the best source of evidence on which to base treatment decisions. For such evidence to be utilized meaningfully, however, it is essential that results are interpreted correctly. This requires a good understanding of strengths and weaknesses of the adopted design, the clinical relevance of the outcome measures, and the many factors that could affect such outcomes. As a general rule, uncontrolled studies tend to provide misleading evidence as a result of the impact of confounders such as regression to the mean, patient‐related bias, and observer bias. On the other hand, although randomized controlled trials (RCTs) are qualitatively superior, aspects of their execution may still decrease their validity. Bias and decreased validity in RCTs may occur by chance alone (for example, treatment groups may not necessarily be balanced for important variables despite randomization) or because of specific features of the trial design. In the case of industry‐driven studies, bias often influences the outcome in favor of the sponsor's product. Factors that need to be carefully scrutinized include (1) the purpose for which the trial is conducted; (2) potential bias due to unblinding or lack of blinding; (3) the appropriateness of the control group; (4) the power of the study in detecting clinically relevant differences; (5) the extent to which eligibility criteria could affect outcomes and be representative of routine clinical practice; (6) whether the treatments being compared are used optimally in terms of dosing, duration of treatment, and other variables; (7) the appropriateness of the statistical comparisons; (8) the clinical relevance of the outcome measures and whether all key outcome information is reported (for example, responder rates in completers); and (9) potential bias in the way results are presented and discussed. This article discusses each of these aspects and illustrates the discussion with examples taken from published antiepileptic drug trials.
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Affiliation(s)
- Emilio Perucca
- C. Mondino National Neurological Institute Pavia Italy.,Division of Clinical and Experimental Pharmacology Department of Internal Medicine and Therapeutics University of Pavia Pavia Italy
| | - Samuel Wiebe
- Department of Clinical Neurosciences and Hotchkiss Brain Institute Cumming School of Medicine University of Calgary Calgary Alberta Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health Cumming School of Medicine University of Calgary Calgary Alberta Canada
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17
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Leone MA, Giussani G, Nevitt SJ, Marson AG, Beghi E. Immediate antiepileptic drug treatment, versus placebo, deferred, or no treatment for first unprovoked seizure. Cochrane Database Syst Rev 2016; 2016:CD007144. [PMID: 27150433 PMCID: PMC6478062 DOI: 10.1002/14651858.cd007144.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is considerable disagreement about the risk of recurrence following a first unprovoked epileptic seizure. A decision about whether to start antiepileptic drug treatment following a first seizure should be informed by information on the size of any reduction in risk of future seizures, the impact on long-term seizure remission, and the risk of adverse effects. OBJECTIVES To review the probability of seizure recurrence, seizure remission, mortality, and adverse effects of antiepileptic drug (AED) treatment given immediately after the first seizure compared to controls, in children and adults. SEARCH METHODS We searched the following databases: Cochrane Epilepsy Group Specialized Register (accessed 13 October 2015), Cochrane Central Register of Controlled Trials (The Cochrane Library September 2015, issue 9, accessed 13 October 2015), PUBMED (accessed 22 April 2015), MEDLINE (Ovid, 1946 to 13 October 2015), EMBASE (accessed 22 April 2015), ClinicalTrials.gov (accessed 15 October 2015), and the WHO International Clinical Trials Registry Platform (ICTRP, accessed 13 October 2015). There were no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs that could be blinded or unblinded. People of any age with a first unprovoked seizure of any type. Included studies compared participants receiving immediate antiepileptic treatment versus those receiving deferred treatment, those assigned to placebo, and those untreated. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the studies identified by the search strategy for inclusion in the review and extracted data. The quality of the evidence was classified in four categories according to the GRADE approach. Dichotomous outcomes were expressed as Risk Ratios (RR) with 95% confidence intervals (CI). Time-to-event outcomes were expressed as Hazard Ratios (HR) with 95% CI. Only one trial used a double-blind design, and the two largest studies were unblinded. Most of the recurrences were generalized tonic-clonic seizures, a major type of seizures that is easily recognised, which should reduce the risk of outcome reporting bias. MAIN RESULTS After exclusion of uninformative papers, only six studies (nine reports) were selected for inclusion. For the two largest studies data were available for individual participant meta-analysis. Compared to controls, participants randomised to immediate treatment had a lower probability of relapse at one year (RR 0.49, 95% CI 0.42 to 0.58, high quality evidence), at five years (RR 0.78; 95% CI 0.68 to 0.89; high quality evidence) and a higher probability of an immediate five-year remission (RR 1.25; 95% CI 1.02 to 1.54, high quality evidence). However there was no difference between immediate treatment and control in terms of five year remission at any time (RR 1.02, 95% CI 0.87 to 1.21, high quality evidence). Antiepileptic drugs did not affect overall mortality after a first seizure (RR 1.16; 95% CI 0.69 to 1.95, high quality evidence). Compared to deferred treatment (RR 1.49, 95% CI 1.23 to 1.79, moderate quality evidence), treatment of the first seizure was associated with a significantly higher risk of adverse events. Moderate to low quality imprecise evidence was available for the association of treatment of the first seizure compared to no treatment or placebo (RR 14.50, 95% CI 1.93 to 108.76) and(RR 4.91, 95% CI 1.10 to 21.93) respectively) AUTHORS' CONCLUSIONS Treatment of the first unprovoked seizure reduces the risk of a subsequent seizure but does not affect the proportion of patients in remission in the long-term. Antiepileptic drugs are associated with adverse events, and there is no evidence that they reduce mortality. In light of this review, the decision to start antiepileptic drug treatment following a first unprovoked seizure should be individualized and based on patient preference, clinical, legal, and socio-cultural factors.
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Affiliation(s)
- Maurizio A Leone
- IRCCS "Casa Sollievo della Sofferenza"SC NeurologiaV.le Cappuccini 1San Giovanni RotondoItaly71013
| | - Giorgia Giussani
- Laboratorio di Malattie Neurologiche, IRCCS‐Istituto di Ricerche Farmacologiche Mario NegriVia La Masa, 19MilanoMilanoItaly20156
| | - Sarah J Nevitt
- University of LiverpoolDepartment of BiostatisticsBlock F, Waterhouse Building1‐5 Brownlow HillLiverpoolUKL69 3GL
| | - Anthony G Marson
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneFazakerleyLiverpoolMerseysideUKL9 7LJ
| | - Ettore Beghi
- Laboratorio di Malattie Neurologiche, IRCCS‐Istituto di Ricerche Farmacologiche Mario NegriVia La Masa, 19MilanoMilanoItaly20156
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Pourzitaki C, Tsaousi G, Apostolidou E, Karakoulas K, Kouvelas D, Amaniti E. Efficacy and safety of prophylactic levetiracetam in supratentorial brain tumour surgery: a systematic review and meta-analysis. Br J Clin Pharmacol 2016; 82:315-25. [PMID: 26945547 DOI: 10.1111/bcp.12926] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/05/2016] [Accepted: 03/02/2016] [Indexed: 01/01/2023] Open
Abstract
AIMS The aim of this study was to perform an up-to-date systematic review and meta-analysis on the efficacy and safety of prophylactic administration of levetiracetam in brain tumour patients. METHOD A systematic review of studies published until April 2015 was conducted using Scopus/Elsevier, EMBASE and MEDLINE. The search was limited to articles reporting results from adult patients, suffering from brain tumour, undergoing supratentorial craniotomy for tumour resection or biopsy and administered levetiracetam in the perioperative period for seizure prophylaxis. Outcomes included the efficacy and safety of levetiracetam, as well as the tolerability of the specific regimen, defined by the discontinuation of the treatment due to side effects. RESULTS The systematic review included 1148 patients from 12 studies comparing levetiracetam with no treatment, phenytoin and valproate, while only 243 patients from three studies, comparing levetiracetam vs phenytoin efficacy and safety, were included in the meta-analysis. The combined results from the meta-analysis showed that levetiracetam administration was followed by significantly fewer seizures than treatment with phenytoin (OR = 0.12 [0.03-0.42]: χ(2) = 1.76: I(2) = 0%). Analysis also showed significantly fewer side effects in patients receiving levetiracetam, compared to other groups (P < 0.05). The combined results showed fewer side effects in the levetiracetam group compared to the phenytoin group (OR = 0.65 [0.14-2.99]: χ(2) = 8.79: I(2) = 77%). CONCLUSIONS The efficacy of prophylaxis with levetiracetam seems to be superior to that with phenytoin and valproate administration. Moreover, levetiracetam use demonstrates fewer side effects in brain tumour patients. Nevertheless, high risk of bias and moderate methodological quality must be taken into account when considering these results.
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Affiliation(s)
- Chryssa Pourzitaki
- 1st Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Georgia Tsaousi
- Clinic of Anaesthesiology and Intensive Care, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Eirini Apostolidou
- 2nd Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Konstantinos Karakoulas
- Clinic of Anaesthesiology and Intensive Care, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Dimitrios Kouvelas
- 2nd Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Ekaterini Amaniti
- Clinic of Anaesthesiology and Intensive Care, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
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Hanaya R, Arita K. The New Antiepileptic Drugs: Their Neuropharmacology and Clinical Indications. Neurol Med Chir (Tokyo) 2016; 56:205-20. [PMID: 26935782 PMCID: PMC4870175 DOI: 10.2176/nmc.ra.2015-0344] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The administration of antiepileptic drugs (AEDs) is the first treatment of epilepsy, one of the most common neurological diseases. Therapeutic guidelines include newer AEDs as front-line drugs; monotherapy with new AEDs is delivered in Japan. While about 70% of patients obtain good seizure control by taking one to three AEDs, about 60% experience adverse effects and 33% have to change drugs. Compared to traditional AEDs, the prolonged administration of new AEDs elicits fewer adverse effects and fewer drug interactions and their teratogenicity may be lower. These characteristics increase drug compliance and allow combination therapy for drug-resistant epilepsy, although the antiepileptic effects of the new AEDs are not greater than of traditional AEDs. Comorbidities are not rare in epileptics; many adult patients present with stroke and brain tumors. In stroke patients requiring risk control and in chemotherapy-treated brain tumor patients, their fewer drug interactions render the new AEDs advantageous. Also, new AEDs offer favorable side benefits for concurrent diseases and conditions. Patients with stroke and traumatic brain injury often present with psychiatric/behavioral symptoms and cognitive impairment and some new AEDs alleviate such symptoms. This review presents an outline of the new AEDs used to treat adult patients based on the pharmacological activity of the drugs and discusses possible clinical indications from the perspective of underlying causative diseases and comorbidities.
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Affiliation(s)
- Ryosuke Hanaya
- Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences
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Ferlisi M, Zanoni T, Moretto G, Pasqualin A. Seizures and Brain Arterovenous Malformation: A Surgical Series. ACTA NEUROCHIRURGICA SUPPLEMENT 2016; 123:147-51. [DOI: 10.1007/978-3-319-29887-0_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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