Prophylactic AEDs in glioma patients

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  • Would Mr RM benefited from prophylactic anti-epileptic?
  • Those that receive prophylactic AEDs have 0.94 times the risk of seizure compared to those that dont recieved AEDs It is estimated that people on prophylactic AEDs are at 94% of the risk of sz cf. with control There was no difference b/w Rx and placebo or watching the patient in preventing the first seizure in 404 patients
  • Those that recieve prophylactic AEDs have 6times the risk of seizure compared to those that dont recieved AEDs It is estimated that people on prophylactic AEDs are at 600% of the risk of sz cf. with control
  • Prophylactic AEDs in glioma patients

    1. 1. EBS presentation: The effectiveness of prophylactic anti-epileptic drugs on adult glioma patients <ul><li>Scholar: Dr Jonathan Li </li></ul><ul><li>Senior Scholar: Dr Andrew Davidson </li></ul>
    2. 2. Mr RM <ul><li>82 yo male </li></ul><ul><li>Presented with 2 months of subtle word finding difficulties </li></ul><ul><li>Histopath result of grade 3 anaplastic astrocytoma </li></ul><ul><li>Symptom free post op </li></ul><ul><li>Represented day 12 post op with seizure involving transient right hemiparesis and dysphasia </li></ul><ul><li>Symptoms resolved on phenytoin </li></ul>
    3. 3. Clinical question <ul><li>Does anti-epileptic drugs (AEDs) prevent new onset of seizures in adult patients with glioma? </li></ul><ul><li>P patients with glioma </li></ul><ul><li>I anticonvulsant prophylaxis </li></ul><ul><li>C placebo or no anticonvulsant </li></ul><ul><li>O seizure prevention </li></ul>
    4. 4. Search Strategy <ul><li>Cochrane </li></ul><ul><ul><li>“ Anti-epileptic” and “brain tumors” </li></ul></ul><ul><ul><li>one Cochrane review available from 2008 </li></ul></ul><ul><li>Medline </li></ul><ul><ul><li>Combine : Brain tumo*r, Anti-epileptic, prophylaxis </li></ul></ul><ul><ul><li>Limit to 2007 onwards </li></ul></ul><ul><li>Scopus </li></ul><ul><ul><li>To check and trace citations </li></ul></ul>
    5. 7. Search results <ul><li>Medline: </li></ul><ul><ul><li>3 case reports </li></ul></ul><ul><ul><li>6 papers on pharmacology </li></ul></ul><ul><ul><li>2 review article on epilepsy and brain tumour </li></ul></ul><ul><ul><li>1 Cochrane review </li></ul></ul><ul><ul><li>1 retrospective case series </li></ul></ul><ul><li>Scopus: </li></ul><ul><ul><li>1 prospective cohort case series </li></ul></ul>
    6. 8. Cochrane Review Paper: Antiepileptic drugs for preventing seizures in people with brain tumours (Tremont-Lukats et al. , 2008) <ul><li>Objectives: </li></ul><ul><li>To determine if seizure prophylaxis with AEDs is effective in people with brain tumour </li></ul><ul><li>To estimate the adverse event rate from prophylactic AEDs </li></ul><ul><li>Methods: </li></ul><ul><li>Include controlled clinical trials with random allocation </li></ul><ul><li>Types of participants included a wide range of brain tumors </li></ul><ul><li>Intervention was prophylaxis vs. no prophylaxis </li></ul><ul><li>Excluded studies comparing two AEDs agents </li></ul>
    7. 9. Cochrane Review Paper: Antiepileptic drugs for preventing seizures in people with brain tumours (Tremont-Lukats et al. , 2008) <ul><li>Their search results: </li></ul><ul><ul><li>Identified 26 studies from 1454 citations </li></ul></ul><ul><ul><li>5 trials met their inclusion criteria </li></ul></ul><ul><ul><li>21 studies excluded </li></ul></ul>
    8. 10. Cochrane Review Paper: Antiepileptic drugs for preventing seizures in people with brain tumours (Tremont-Lukats et al. , 2008)
    9. 11. Cochrane Review Paper: Antiepileptic drugs for preventing seizures in people with brain tumours (Tremont-Lukats et al. , 2008) 34% 40% 37% 12% 40% Patientwith glioma (%)
    10. 12. Cochrane Review Paper: Antiepileptic drugs for preventing seizures in people with brain tumours (Tremont-Lukats et al. , 2008)
    11. 13. <ul><ul><li>A prospective cohort study of 64 patients who underwent surgical treatment for primary or recurrent glioma (level IV evidence) </li></ul></ul><ul><ul><li>54 patients (84%) had new diagnosis of glioma </li></ul></ul><ul><ul><li>15 patients (23%) were WHO grade III histology </li></ul></ul><ul><ul><li>Outcomes were onset of first seizure and correlation with histology </li></ul></ul><ul><ul><li>Mean follow up was 18.7 ± 11 months; median: 19 months </li></ul></ul><ul><ul><li>27 of 64 patients (42%) had seizure on onset of and recurrence glioma </li></ul></ul><ul><ul><li>Those that were diagnosed with seizure were either commenced on phenytoin or keppra </li></ul></ul><ul><ul><li>Of the 35 patients that did not receive AEDs none had seizure on follow up (12) or at their death (23). </li></ul></ul>Epilepsy in cerebral glioma: timing of appearance and histological correlations (Rosati et al. , 2009)
    12. 14. <ul><ul><li>A retrospective chart review of 164 patients with newly histologically diagnosed glioma (level IV evidence) </li></ul></ul><ul><ul><li>Prophylactic AEDs was given to 27% of patients </li></ul></ul><ul><ul><li>Peri-operative seizures (within 1 week) occured in 2 patients (3% of patients) without AEDs </li></ul></ul><ul><ul><li>No peri-operative seizured for patients with prophylaxis </li></ul></ul><ul><ul><li>Prophylactic AEDs were continued for > 1 week for in 30 patients 18% of patients </li></ul></ul><ul><ul><li>Temporal lobe tumours were more likely to receive prophylaxis (50% vs 20%) </li></ul></ul>Use of peri-operative anti-epileptic drugs in patients with newly diagnosed high grade malignant glioma: a single center experience (Lwu et al. , 2009)
    13. 15. Conclusion <ul><li>Does anti-epileptic drugs (AEDs) prevent new onset of seizures in adult patients with glioma? </li></ul><ul><li>“ The evidence is neutral, neither for nor against seizure prophylaxis, in people with brain tumours” </li></ul><ul><li>This evidence only applies to the certain AEDs </li></ul><ul><li>It is unknown whether the same efficacy holds for newer AEDs </li></ul>

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