Retrospective analysis of the efficacy and tolerability of levetiracetam in brain tumor patients (original) (raw)

Summary

Seizures are a common complication of primary (PBT) and metastatic (MBT) brain tumors, affecting approximately 50% of all patients during the course of their illness. Anti-convulsant therapy of these tumor-induced seizures is often inadequate with conventional anti-epileptic drugs (AEDs), due to a variety of factors, including activation of glutaminergic NMDA receptors, immune-mediated neuronal damage, and anatomic alterations of neuronal input pathways. Levetiracetam (LEV) is a new AED with a novel mechanism of action, which includes reducing the Ca++ current through neuron-specific, high voltage activated Ca++ channels (n-type). Because of this unique mechanism, it has been postulated that LEV may be effective in controlling tumor-induced seizures. A retrospective chart review was performed of all patients who had received LEV for seizure control. Forty-one patients were reviewed (22 female, 19 male), with a median age of 47.5 years (range 25–81). There were 34 patients with PBT and 7 with MBT. LEV was used as an add-on AED in 33 patients and as monotherapy in eight patients, with a median dose of 1500 mg/day (range 500–3500). The baseline median seizure frequency for the cohort was 1 per week. After the addition of LEV and follow-up for a minimum of 4 weeks, the median seizure frequency was reduced to 0 per week (59% of patients noted complete seizure control). Overall, the seizure frequency was reduced in 90% of patients (P<0.0001; Sign test). The most common toxicity was somnolence, noted in 37% of patients. LEV was very effective and well tolerated in brain tumor patients with seizures, and should be considered for add-on therapy to current AEDs, or as a substitute anti-convulsant for monotherapy.

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Acknowledgements

The Authors would like to thank Ryan Smith for research assistance. Dr. Newton was supported in part by an unrestricted Clinical Grant from UCB Pharma, Inc., National Cancer Institute Grant, CA 16058, and the Esther Dardinger Neuro-Oncology Center Endowment Fund.

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Authors and Affiliations

  1. Dardinger Neuro-Oncology Center and Division of Neuro-Oncology, Department of Neurology, Ohio State University Medical Center, Columbus, Ohio, USA
    Herbert B. Newton
  2. School of Medicine and Public Health, James Cancer Hospital & Solove Research Institute, Columbus, Ohio, USA
    Samuel A. Goldlust
  3. Department of Statistics, The Ohio State University Medical Center and James Cancer Hospital & Solove Research Institute, Columbus, Ohio, USA
    Dennis Pearl
  4. Dardinger Neuro-Oncology Center and Division of Neuro-Oncology, Department of Neurology Ohio State University Medical Center, 465 Means Hall, 1654 Upham Drive , Columbus, Ohio, 43210, USA
    Herbert B. Newton

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  1. Herbert B. Newton
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  2. Samuel A. Goldlust
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  3. Dennis Pearl
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Correspondence toHerbert B. Newton.

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Newton, H.B., Goldlust, S.A. & Pearl, D. Retrospective analysis of the efficacy and tolerability of levetiracetam in brain tumor patients.J Neurooncol 78, 99–102 (2006). https://doi.org/10.1007/s11060-005-9070-4

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