RESUMO
OBJECTIVE: To identify risk factors for the development of tumor-associated epilepsy (TAE) and potential benefit of newer generation AEDs in seizure prevention. METHODS: We performed an IRB approved retrospective study of newly diagnosed GBM patients at the University of Rochester between 1/1/05 and 5/13/11. Records were reviewed to describe demographics, seizure incidence, occurrence of status epilepticus, and AED use and toxicity. RESULTS: 172 patients with newly diagnosed GBM were included in the study. 53.4% developed TAE. 31.4% had seizure prior to diagnosis. 118 patients were seizure-free at diagnosis: 32.2% developed post-diagnosis TIE (PostTAE) and 60.2% remained seizure-free. 70 seizure-free patients received an AED peri-operatively. 36 were weaned off AEDs and 31 were continued. Incidence of PostTAE and time to first seizure were comparable in AED-treated and untreated patients. 4 PostTAE patients presented with status epilepticus (SE), all were not AED treated. AEDs were withdrawn in 10 patients due to toxicity: 9 from phenytoin and 1 from levetiracetam. CONCLUSION: There is a high incidence of PostTAE in GBM. Prophylactic AED therapy did not reduce PostTAE but may have prevented SE. Minimal toxicity was observed on 2nd generation AEDs. The high burden of epilepsy in this population and tolerability of newer AEDS suggest that AAN guidelines should be revisited.
Assuntos
Anticonvulsivantes/uso terapêutico , Neoplasias Encefálicas/complicações , Fenitoína/uso terapêutico , Piracetam/análogos & derivados , Convulsões/tratamento farmacológico , Estado Epiléptico/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Levetiracetam , Masculino , Pessoa de Meia-Idade , Piracetam/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Convulsões/etiologia , Convulsões/prevenção & controle , Estado Epiléptico/etiologia , Estado Epiléptico/prevenção & controle , Resultado do TratamentoRESUMO
Medical management, the mainstay of treatment for partial epilepsy, involves choosing from an array of antiseizure drugs, most of which have comparable efficacy against partial-onset seizures. Effective treatment strategies involve matching the characteristics of drug and patient to control seizures without adverse effects, a task that requires familiarity with the potential advantages and drawbacks of individual antiseizure drugs. For medically refractory partial epilepsy, resective surgical procedures should be considered. If the patient is not a surgical candidate, the vagus nerve stimulator or ketogenic diet may improve seizure control in selected cases. Emerging therapies include medications with novel mechanisms of action, deep brain stimulators, and cortical stimulators that respond to neural patterns of seizure activity.