The Korean Society for Neuro-Oncology (KSNO) Guideline for Antiepileptic Drug Usage of Brain Tumor: Version 2021.1

Evidence-based recommendations for the prophylactic use of antiseizure medications (ASMs) in neurosurgery: a systematic review of guidelines

OBJECTIVE

This study aims to evaluate the methodological quality of guidelines concerning the prophylactic use of antiseizure medications (ASMs) in neurosurgery and to summarize relevant recommendations.

METHODS

PubMed, Embase, MEDLINE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database (VIP), National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), and other guideline repositories and official organizations were searched from 2004 to 2023 (20 years). The extracted information consisted of the guideline characteristics, relevant recommendations, levels of evidence, and strength of recommendations. Using the Guideline Research and Evaluation Tool II (AGREE II), five reviewers assessed the methodological quality of the guidelines, and the intraclass correlation coefficient (ICC) is used to assess the inter-reviewer consistency.

RESULTS

Of 27 eligible guidelines, AGREE II scores varied with higher scores in Clarity of Presentation (88.89%), Scope and Purpose (83.33%), and Editorial Independence (72.92%), but lower in Rigor of Development (59.17%), Stakeholder Involvement (46.67%), and Applicability (41.67%). ICC ranged from 0.51 to 0.92. Nine guidelines were recommended, eight with modifications, and ten not recommended. ASMs prophylaxis are recommended for patients with a seizure history, which means secondary prophylaxis, and specific high-risk groups, but not recommended for primary prophylaxis routinely for those without a history of seizure.

CONCLUSIONS

Guidelines in neurosurgical perioperative prophylactic use of ASMs are of moderate quality with domains for enhancement. Guidelines lack detailed guidance on medication initiation, dosage, and duration, highlighting the need for more high-quality clinical trials comparing newer and classical ASMs.

Levetiracetam as a sensitizer of concurrent chemoradiotherapy in newly diagnosed glioblastoma: An open-label phase 2 study

BACKGROUND

An open-label single-arm phase 2 study was conducted to evaluate the role of levetiracetam as a sensitizer of concurrent chemoradiotherapy (CCRT) for patients with newly diagnosed glioblastoma. This study aimed to determine the survival benefit of levetiracetam in conjunction with the standard treatment for glioblastoma.

METHODS

Major eligibility requirements included histologically proven glioblastoma in the supratentorial region, patients 18 years or older, and Eastern Cooperative Oncology Group (ECOG) performance status of 0-2. Levetiracetam was given at 1,000-2,000 mg daily in two divided doses during CCRT and adjuvant chemotherapy thereafter. The primary and the secondary endpoints were 6-month progression-free survival (6mo-PFS) and 24-month overall survival (24mo-OS), respectively. Outcomes of the study group were compared to those of an external control group.

RESULTS

Between July 2016 and January 2019, 76 patients were enrolled, and 73 patients were included in the final analysis. The primary and secondary outcomes were improved in the study population compared to the external control (6mo-PFS, 84.9% vs. 72.3%, p = 0.038; 24mo-OS, 58.0% vs. 39.9%, p = 0.018), but the differences were less prominent in a propensity score-matched analysis (6mo-PFS, 88.0% vs. 76.9%, p = 0.071; 24mo-OS, 57.1% vs. 38.8%, p = 0.054). In exploratory subgroup analyses, some results suggested that patients with ages under 65 years or unmethylated MGMT promoter might have a greater survival benefit from the use of levetiracetam.

CONCLUSIONS

The use of levetiracetam during CCRT in patients with newly diagnosed glioblastoma may result in improved outcomes, but further investigations are warranted.