Prophylactic antiepileptic drug therapy in patients undergoing supratentorial meningioma resection: a systematic analysis of efficacy

A review

Ricardo J. KomotarDepartment of Neurological Surgery, Memorial Sloan–Kettering Cancer Center, New York, New York;

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Daniel M. S. RaperRoyal North Shore Hospital, Sydney, Australia; and

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Robert M. StarkeDepartment of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia

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J. Bryan IorgulescuDepartment of Neurological Surgery, Memorial Sloan–Kettering Cancer Center, New York, New York;

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Philip H. GutinDepartment of Neurological Surgery, Memorial Sloan–Kettering Cancer Center, New York, New York;

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Object

Meningiomas are one of the more common intracranial neoplasms. The risk of seizures and secondary aspiration, brain edema, and brain injury often leads practitioners to administer prophylactic antiepileptic drugs (AEDs) perioperatively. The efficacy of this practice remains controversial, however, with prior investigations reaching conflicting results and recent studies focusing on AED side effects. The authors performed a systematic analysis of outcomes following supratentorial meningioma resection with and without prophylactic AED administration in the hope of clarifying the role of AEDs in the perioperative care of patients with these lesions.

Methods

A MEDLINE search of the literature (1979–2010) was performed. Comparisons were made for patient and tumor characteristics as well as success of repair, morbidity, and seizure outcome. Statistical analyses of categorical variables were undertaken using chi-square and Fisher exact tests.

Results

Nineteen studies, involving 698 patients, were included. There were no significant differences in the extent of resection, perioperative mortality, or recurrence between the AED and no-AED cohorts. Likewise, there were no significant differences in the incidence of early or late seizures between the cohorts.

Conclusions

The results of this systematic analysis supports the conclusion that the prophylactic administration of anticonvulsants during resection of supratentorial meningiomas provides no benefit in the prevention of either early or late postoperative seizures. Despite their traditional role in this patient population, the routine use of AEDs should be carefully reconsidered.

Abbreviation used in this paper:

AED = antiepileptic drug.
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  • 1

    Agbi CB, & Bernstein M: Seizure prophylaxis for brain tumour patients. Brief review and guide for family physicians. Can Fam Physician 39:11531156, 1993. (Erratum in Can Fam Physician 39:1556, 1993)

    • Search Google Scholar
    • Export Citation
  • 2

    Andrews BT, & Wilson CB: Suprasellar meningiomas: the effect of tumor location on postoperative visual outcome. J Neurosurg 69:523528, 1988

    • Search Google Scholar
    • Export Citation
  • 3

    Baker CJ, , Prestigiacomo CJ, & Solomon RA: Short-term perioperative anticonvulsant prophylaxis for the surgical treatment of low-risk patients with intracranial aneurysms. Neurosurgery 37:863871, 1995

    • Search Google Scholar
    • Export Citation
  • 4

    Beaumont A, & Whittle IR: The pathogenesis of tumour associated epilepsy. Acta Neurochir (Wien) 142:115, 2000

  • 5

    Beenen LF, , Lindeboom J, , Kasteleijn-Nolst Trenité DG, , Heimans JJ, , Snoek FJ, & Touw DJ, et al.: Comparative double blind clinical trial of phenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy: efficacy, tolerability, and cognitive effects. J Neurol Neurosurg Psychiatry 67:474480, 1999

    • Search Google Scholar
    • Export Citation
  • 6

    Behari S, , Giri PJ, , Shukla D, , Jain VK, & Banerji D: Surgical strategies for giant medial sphenoid wing meningiomas: a new scoring system for predicting extent of resection. Acta Neurochir (Wien) 150:865877, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Brodie MJ, & Leach JP: Success or failure with antiepileptic drug therapy: beyond empiricism?. Neurology 60:162163, 2003

  • 8

    Chozick BS, , Reinert SE, & Greenblatt SH: Incidence of seizures after surgery for supratentorial meningiomas: a modern analysis. J Neurosurg 84:382386, 1996

    • Search Google Scholar
    • Export Citation
  • 9

    Curry WJ, & Kulling DL: Newer antiepileptic drugs: gabapentin, lamotrigine, felbamate, topiramate and fosphenytoin. Am Fam Physician 57:513520, 1998

    • Search Google Scholar
    • Export Citation
  • 10

    DeAngelis LM: Brain tumors. N Engl J Med 344:114123, 2001

  • 11

    Deutschman CS, & Haines SJ: Anticonvulsant prophylaxis in neurological surgery. Neurosurgery 17:510517, 1985

  • 12

    Findler G, & Lavy S: Transient hemiparesis: a rare manifestation of diphenylhydantoin toxicity. Report of two cases. J Neurosurg 50:685687, 1979

    • Search Google Scholar
    • Export Citation
  • 13

    Gazzeri R, , Galarza M, & Gazzeri G: Giant olfactory groove meningioma: ophthalmological and cognitive outcome after bifrontal microsurgical approach. Acta Neurochir (Wien) 150:11171126, 2008

    • Search Google Scholar
    • Export Citation
  • 14

    Gelabert-González M, , García-Allut A, , Bandín-Diéguez J, , Serramito-García R, & Martínez-Rumbo R: Meningiomas of the lateral ventricles. A review of 10 cases. Neurocirugia (Astur) 19:427433, 2008

    • Search Google Scholar
    • Export Citation
  • 15

    Glantz MJ, , Cole BF, , Forsyth PA, , Recht LD, , Wen PY, & Chamberlain MC, et al.: Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 54:18861893, 2000

    • Search Google Scholar
    • Export Citation
  • 16

    Herscovici Z, , Rappaport Z, , Sulkes J, , Danaila L, & Rubin G: Natural history of conservatively treated meningiomas. Neurology 63:11331134, 2004

    • Search Google Scholar
    • Export Citation
  • 17

    Jallo GI, & Benjamin V: Tuberculum sellae meningiomas: microsurgical anatomy and surgical technique. Neurosurgery 51:14321440, 2002

  • 18

    Kilpatrick C, , Kaye A, , Dohrmann P, , Gonzales M, & Hopper J: Epilepsy and primary cerebral tumours. J Clin Neurosci 1:178181, 1994

  • 19

    Kurzwelly D, , Herrlinger U, & Simon M: Seizures in patients with low-grade gliomas—incidence, pathogenesis, surgical management, and pharmacotherapy. Adv Tech Stand Neurosurg 35:81111, 2010

    • Search Google Scholar
    • Export Citation
  • 20

    Lee ST, , Lui TN, , Chang CN, , Cheng WC, , Wang DJ, & Heimburger RF, et al.: Prophylactic anticonvulsants for prevention of immediate and early postcraniotomy seizures. Surg Neurol 31:361364, 1989

    • Search Google Scholar
    • Export Citation
  • 21

    Lieu AS, & Howng SL: Intracranial meningiomas and epilepsy: incidence, prognosis and influencing factors. Epilepsy Res 38:4552, 2000

  • 22

    Mattson RH, , Cramer JA, , Collins JF, , Smith DB, , Delgado-Escueta AV, & Browne TR, et al.: Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures. N Engl J Med 313:145151, 1985

    • Search Google Scholar
    • Export Citation
  • 23

    Michelucci R: Optimizing therapy of seizures in neurosurgery. Neurology 67:12 Suppl 4 S14S18, 2006

  • 24

    Mintzer S: Metabolic consequences of antiepileptic drugs. Curr Opin Neurol 23:164169, 2010

  • 25

    Morokoff AP, , Zauberman J, & Black PM: Surgery for convexity meningiomas. Neurosurgery 63:427434, 2008

  • 26

    North JB, , Penhall RK, , Hanieh A, , Frewin DB, & Taylor WB: Phenytoin and postoperative epilepsy. A double-blind study. J Neurosurg 58:672677, 1983

    • Search Google Scholar
    • Export Citation
  • 27

    North JB, , Penhall RK, , Hanieh A, , Hann CS, , Challen RG, & Frewin DB: Postoperative epilepsy: a double-blind trial of phenytoin after craniotomy. Lancet 1:384386, 1980

    • Search Google Scholar
    • Export Citation
  • 28

    O'Reilly RA, & Hamilton RD: Acquired hemophilia, meningioma, and diphenylhydantoin therapy. J Neurosurg 53:600605, 1980

  • 29

    Ohigashi Y, & Tanabe A: A huge frontal meningioma associated with intraoperative massive bleeding and severe brain swelling—case report. J Clin Neurosci 8:Suppl 1 5458, 2001

    • Search Google Scholar
    • Export Citation
  • 30

    Otani N, , Muroi C, , Yano H, , Khan N, , Pangalu A, & Yonekawa Y: Surgical management of tuberculum sellae meningioma: role of selective extradural anterior clinoidectomy. Br J Neurosurg 20:129138, 2006

    • Search Google Scholar
    • Export Citation
  • 31

    Patsalos PN, , Fröscher W, , Pisani F, & van Rijn CM: The importance of drug interactions in epilepsy therapy. Epilepsia 43:365385, 2002

  • 32

    Porter KR, , McCarthy BJ, , Freels S, , Kim Y, & Davis FG: Prevalence estimates for primary brain tumors in the United States by age, gender, behavior, and histology. Neuro Oncol 12:520527, 2010

    • Search Google Scholar
    • Export Citation
  • 33

    Puchner MJA, , Fischer-Lampsatis RCM, , Herrmann HD, & Freckmann N: Suprasellar meningiomas—neurological and visual outcome at long-term follow-up in a homogeneous series of patients treated microsurgically. Acta Neurochir (Wien) 140:12311238, 1998

    • Search Google Scholar
    • Export Citation
  • 34

    Rekling JC: Neuroprotective effects of anticonvulsants in rat hippocampal slice cultures exposed to oxygen/glucose deprivation. Neurosci Lett 335:167170, 2003

    • Search Google Scholar
    • Export Citation
  • 35

    Rüegg S: Dexamethasone/phenytoin interactions: neurooncological concerns. Swiss Med Wkly 132:425426, 2002

  • 36

    Shamji MF, , Fric-Shamji EC, & Benoit BG: Brain tumors and epilepsy: pathophysiology of peritumoral changes. Neurosurg Rev 32:275286, 2009

    • Search Google Scholar
    • Export Citation
  • 37

    Sirven JI, , Wingerchuk DM, , Drazkowski JF, , Lyons MK, & Zimmerman RS: Seizure prophylaxis in patients with brain tumors: a meta-analysis. Mayo Clin Proc 79:14891494, 2004

    • Search Google Scholar
    • Export Citation
  • 38

    Strolin Benedetti M, , Whomsley R, , Nicolas JM, , Young C, & Baltes E: Pharmacokinetics and metabolism of 14C-levetiracetam, a new antiepileptic agent, in healthy volunteers. Eur J Clin Pharmacol 59:621630, 2003

    • Search Google Scholar
    • Export Citation
  • 39

    Sughrue ME, , Rutkowski MJ, , Chang EF, , Shangari G, , Kane AJ, & McDermott MW, et al.: Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated? Clinical article. J Neurosurg 114:705709, 2011

    • Search Google Scholar
    • Export Citation
  • 40

    Surawicz TS, , McCarthy BJ, , Kupelian V, , Jukich PJ, , Bruner JM, & Davis FG: Descriptive epidemiology of primary brain and CNS tumors: results from the Central Brain Tumor Registry of the United States, 1990-1994. Neuro Oncol 1:1425, 1999

    • Search Google Scholar
    • Export Citation
  • 41

    Tanabe M, , Umeda M, , Honda M, & Ono H: Phenytoin and carbamazepine delay the initial depression of the population spike upon exposure to in vitro ischemia and promote its postischemic functional recovery in rat hippocampal slices. Eur J Pharmacol 553:104108, 2006

    • Search Google Scholar
    • Export Citation
  • 42

    Tellez-Zenteno JF, , Sadanand V, , Riesberry M, , Robinson CA, , Ogieglo L, & Masiowski P, et al.: Epilepsy surgery in the elderly: an unusual case of a 75-year-old man with recurrent status epilepticus. Epileptic Disord 11:144149, 2009

    • Search Google Scholar
    • Export Citation
  • 43

    Tsai MC, & Huang TL: Generalized anxiety disorder in a patient prior to the diagnosis of left temporal lobe meningioma: a case report. Prog Neuropsychopharmacol Biol Psychiatry 33:10821083, 2009

    • Search Google Scholar
    • Export Citation
  • 44

    Tsuji M, , Shinomiya S, , Inoue R, & Sato K: Prospective study of postoperative seizure in intracranial meningioma. Jpn J Psychiatry Neurol 47:331334, 1993

    • Search Google Scholar
    • Export Citation
  • 45

    van Breemen MS, , Wilms EB, & Vecht CJ: Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 6:421430, 2007

    • Search Google Scholar
    • Export Citation
  • 46

    Vecht CJ, , Wagner GL, & Wilms EB: Interactions between antiepileptic and chemotherapeutic drugs. Lancet Neurol 2:404409, 2003

  • 47

    Yap KY, , Chui WK, & Chan A: Drug interactions between chemotherapeutic regimens and antiepileptics. Clin Ther 30:13851407, 2008

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