SNO and EANO practice guideline update: Anticonvulsant prophylaxis in patients with newly diagnosed brain tumors

Tobias Walbert; Rebecca A Harrison; David Schiff; Edward K Avila; Merry Chen; Padmaja Kandula; Jong Woo Lee; Emilie Le Rhun; Glen H J Stevens; Michael A Vogelbaum; Wolfgang Wick; Michael Weller; Patrick Y Wen; Elizabeth R Gerstner

doi:10.1093/neuonc/noab152

SNO and EANO practice guideline update: Anticonvulsant prophylaxis in patients with newly diagnosed brain tumors

Neuro Oncol. 2021 Nov 2;23(11):1835-1844. doi: 10.1093/neuonc/noab152.

Authors

Affiliations

¹ Department of Neurology and Neurosurgery, Henry Ford Health System and Wayne State University, Detroit, Michigan, USA.
² Department of Neuro-oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
³ Department of Neurology, University of Virginia Health System, Charlottesville, Virginia, USA.
⁴ Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁵ Division of Clinical Neurophysiology and Epilepsy, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA.
⁶ Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁷ Department of Neurology and Neurosurgery, Brain Tumor Center & Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.
⁸ Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio, USA.
⁹ Department of NeuroOncology, Moffitt Cancer Center, Tampa, Florida, USA.
¹⁰ Neurology Clinic and Neurooncology Program, Heidelberg University and German Cancer Research Center, Heidelberg, Germany.
¹¹ Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
¹² Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
¹³ Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹⁴ Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA.

Abstract

Objective: To update the 2000 American Academy of Neurology (AAN) practice parameter on anticonvulsant prophylaxis in patients with newly diagnosed brain tumors.

Methods: Following the 2017 AAN methodologies, a systematic literature review utilizing PubMed, EMBASE Library, Cochrane, and Web of Science databases was performed. The studies were rated based on the AAN therapeutic or causation classification of evidence (class I-IV).

Results: Thirty-seven articles were selected for final analysis. There were limited high-level, class I studies and mostly class II and III studies. The AAN affirmed the value of these guidelines.

Recommendations: In patients with newly diagnosed brain tumors who have not had a seizure, clinicians should not prescribe antiepileptic drugs (AEDs) to reduce the risk of seizures (level A). In brain tumor patients undergoing surgery, there is insufficient evidence to recommend prescribing AEDs to reduce the risk of seizures in the peri- or postoperative period (level C). There is insufficient evidence to support prescribing valproic acid or levetiracetam with the intent to prolong progression-free or overall survival (level C). Physicians may consider the use of levetiracetam over older AEDs to reduce side effects (level C). There is insufficient evidence to support using tumor location, histology, grade, molecular/imaging features when deciding whether or not to prescribe prophylactic AEDs (level U).

Keywords: GBM; antiepileptic drug; glioma; guideline; seizure.

Publication types

Systematic Review

MeSH terms

Anticonvulsants* / therapeutic use
Brain Neoplasms* / drug therapy
Humans
Postoperative Period
Seizures / drug therapy
Valproic Acid / therapeutic use

Substances

Anticonvulsants
Valproic Acid