This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Paul L. Moots, MD; Robert J. Maciunas, MD; Donald R. Eisert, MD; Robert A. Parker, DSc; Kazel Laporte, RN; Bassel Abou-Khalil, MD

Arch Neurol. 1995;52(7):717-724.

Abstract
Objective
To describe the morbidity associated with seizures and the efficacy of anticonvulsant therapy in adult patients with malignant gliomas (MGs).

Study Design
A retrospective review of charts was performed to determine the occurrence of seizures at diagnosis, the frequency and character of subsequent seizures, and the use and toxic side effects of anticonvulsants.

Patients
Sixty-five consecutive adult patients with supratentorial MGs who were examined in the neurooncology clinic at a university medical center were studied. The diagnosis was glioblastoma in 47 of the patients, and it was anaplastic astrocytoma in 18 patients. The mean age of the patients was 49.5 years. The median Karnofsky status score was 80. The median survival was 18 months.

Results
Twenty-nine patients presented with seizures, and 21 21 of these had subsequent (eg, "recurrent") seizures while they were receiving anticonvulsant therapy. Ten of 36 patients who were free of seizures at diagnosis experienced seizures after diagnosis (eg, "late onset") while they were being treated with anticonvulsants, including five patients who had single seizures. Long-term seizure frequency in excess of one per month was observed in 13 patients. Ten patients had episodes of partial motor status epilepticus. Most recurrent and late-onset seizures occurred despite therapeutic anticonvulsant levels, and without evidence of tumor progression. Rash associated with anticonvulsants was observed in 26% of the patients. Other clinically important toxic side effects were observed in 14% of the patients who were receiving long-term anticonvulsant therapy.

Conclusions
Seizures contributed substantially to the neurologic morbidity of MGs in at least 25% of these patients. The occurrence of seizures at diagnosis was a strong predictor of subsequent seizures, and in many patients, seizures proved to be refractory to standard anticonvulsant therapy. Long-term anticonvulsant toxic side effects are relatively common in patients with MGs. The use of long-term seizure prophylaxis for patients with MGs who are free of seizures at presentation is not clearly beneficial and should be studied in a prospective trial.

Author Affiliations
From the Departments of Neurology (Drs Moots and Abou-Khalil and Ms Laporte), Neurosurgery (Dr Maciunas), Radiation Oncology (Dr Eisert), and Preventive Medicine (Biostatistics) (Dr Parker), Vanderbilt University Medical Center, Nashville, Tenn.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Optimizing therapy of seizures in patients with brain tumors
Vecht and van Breemen
Neurology 2006;67:S10-S13.
ABSTRACT | FULL TEXT  

Clinical Implications of Status Epilepticus in Patients With Neoplasms
Cavaliere et al.
Arch Neurol 2006;63:1746-1749.
ABSTRACT | FULL TEXT  

Epileptic seizures during follow-up of patients treated for primary brain tumors
Hildebrand et al.
Neurology 2005;65:212-215.
ABSTRACT | FULL TEXT  

Seizure Prophylaxis in Patients With Brain Tumors: A Meta-analysis
Sirven et al.
Mayo Clin Proc. 2004;79:1489-1494.
ABSTRACT  

Human Constitutive Androstane Receptor Mediates Induction of CYP2B6 Gene Expression by Phenytoin
Wang et al.
J. Biol. Chem. 2004;279:29295-29301.
ABSTRACT | FULL TEXT  

Gabapentin to Control Seizures in Children Undergoing Cancer Treatment
Khan et al.
J Child Neurol 2004;19:97-101.
ABSTRACT  

Temporal lobe tumoral epilepsy: Characteristics and predictors of surgical outcome
Zaatreh et al.
Neurology 2003;61:636-641.
ABSTRACT | FULL TEXT  

Practice parameter: Anticonvulsant prophylaxis in patients with newly diagnosed brain tumors: Report of the Quality Standards Subcommittee of the American Academy of Neurology
Glantz et al.
Neurology 2000;54:1886-1893.
FULL TEXT  

Comparative double blind clinical trial of phenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy: efficacy, tolerability, and cognitive effects
Beenen et al.
J. Neurol. Neurosurg. Psychiatry 1999;67:474-480.
ABSTRACT | FULL TEXT