Levetiracetam Prevents Seizures During Craniotomy

By Larry Hand

NEW YORK (Reuters Health) - Levetiracetam (LEV) may be more effective than phenytoin (PHT) in preventing seizures during craniotomy in patients with brain tumors, a new study suggests.

"(P)rophylactic LEV in the perioperative period significantly reduced the risk of seizures, and it is recommended for treatment of patients with supratentorial tumors," the study authors conclude.

They warn, however, that their single-center study may have a bias from limited recruitment, and so larger studies are required.

Dr. Toshihiko Iuchi of Chiba Cancer Center in Chiba, Japan, and colleagues randomly assigned 146 patients to receive either LEV, 500 mg q 12 hours, or 15-18 mg/kg fosphenytoin followed by 125 mg q 12 hours, in both cases until postoperative day 7.

LEV courses were completed in all patients, but in five PHT patients treated had to be withdrawn due to liver dysfunction, skin eruption, or atrial fibrillation.

There were no intraoperative seizures. Twelve patients had seizures after surgery: six on the day of surgery, two the day after, two two days after surgery, one five days after surgery, and one six days after surgery.

Overall, the incidence of seizures was 1.4% in the LEV group, vs 15.1% in the PHT group (p=0.005); the odds ratio for being seizure-free was 12.77 for the LEV group compared with the PHT group (p=0.001).

Another limit of the study is that the number of patients being treated at the center with benign tumors was low, the authors point out, which limits generalizability. Also, the manufacturer-recommended dosage used for PHT was in the low therapeutic range and possibly insufficient, they write.

Still, said Dr. Sankalp Gokhale, "They have done a very good job in comparing two drugs."

Dr. Gokhale, assistant professor in the Department of Neurology, Neurotherapeutics, and Neurological Surgery at the University of Texas Southwestern Medical Center in Dallas, was the lead author of a 2013 paper in the Asian Journal of Neurosurgery on use of LEV in craniotomy patients.

"I would probably translate this study into clinical practice," Dr. Gokhale told Reuters Health. "It would be, of course, great if we have more studies having more science. This study was in only one center in Japan."

Another study adding another drug, such as lacosamide, would be useful, said Dr. Gokhale, adding that such a study would probably take only six months to a year.

"It would not be difficult to enroll patients in this kind of trial, and all three drugs are already in use for management of seizure," Dr. Gokhale said.

The authors did not respond to requests for comment.

SOURCE: https://bmj.co/1CPGJGD

J Neurol Neurosurg Psychiatry 2014.

(c) Copyright Thomson Reuters 2015. Click For Restrictions - https://about.reuters.com/fulllegal.asp