Antiepileptic drugs for treating seizures in adults with brain tumours

Seizures are a common symptom of both primary and secondary brain tumours and can cause significant morbidity. The mainstay of treatment for seizures in adults with brain tumours is medical therapy with antiepileptic drugs. This review appraises the evidence for a range of commonly used antiepileptic drugs for the treatment of seizures in adults with brain tumours.

There is a lack of good quality evidence to support the choice of any particular antiepileptic drug for the treatment of seizures in adults with brain tumours. Our searches identified one small randomised trial directly comparing two different antiepileptic drugs (phenytoin and levetiracetam) for the treatment of seizures in adults with brain tumours. No significant difference was identified between the effectiveness of these two drugs. This small study was intended as a feasibility study for a larger trial that was not carried out. We also identified one ongoing study of levetiracetam versus pregabalin for the treatment of seizures in adults undergoing chemotherapy, radiotherapy,or both for primary brain tumours although no data from this study were available at the time of preparing this review. We identified a number of other small studies but we excluded them from the review as they were not randomised controlled trials. There is a clear need for larger randomised controlled trials to study the effectiveness of different antiepileptic drugs in the treatment of seizures in adults with brain tumours.

Authors' conclusions: 

There is a lack of robust, randomised, controlled evidence to support the choice of antiepileptic drug for the treatment of seizures in adults with brain tumours. While some authors support the use of non enzyme-inducing antiepileptic drugs, reliable, comparative evidence to provide clinical justification for this is limited. There is a need for further large, randomised, controlled trials in this area.

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Background: 

Seizures are a common symptom of brain tumours. The mainstay of treatment for seizures is medical therapy with antiepileptic drugs.

Objectives: 

To evaluate the relative effectiveness and tolerability of antiepileptic drugs commonly used to treat seizures in adults with brain tumours.

Search strategy: 

We searched CENTRAL (Issue 2 of 4, The Cochrane Library 2011), MEDLINE (1948 to May week 3, 2011) and EMBASE (1980 to 31 May 2011) databases. In addition, we handsearched articles published since 2000 in the following journals selected by the authors: Epilepsia; The Lancet Neurology and Neuro-Oncology.

Selection criteria: 

Controlled clinical trials with random allocation of the use of antiepileptic drugs to treat seizures in adults with brain tumours.

Data collection and analysis: 

Both review authors screened the search results and reviewed the abstracts of potentially relevant articles before retrieving the full text of eligible articles.

Main results: 

Only one trial met the inclusion criteria for this review which was a small, open-label, unblinded, randomised trial of the safety and feasibility of switching from phenytoin to levetiracetam monotherapy or continuing phenytoin for glioma-related seizure control following craniotomy (Lim 2009). Levetiracetam (a non enzyme-inducing antiepileptic drug) appears to have been at least as well tolerated and as effective as phenytoin (an enzyme-inducing antiepileptic drug) for the treatment of seizures in people with brain tumours. Eighty-seven per cent of participants treated with levetiracetam were free of seizures at six months compared with 75% of participants treated with phenytoin.

There is one ongoing study of levetiracetam versus pregabalin for the treatment of seizures in adults undergoing chemotherapy, radiotherapy,or both for primary brain tumours. No data from this study were available at the time of preparing this review.

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