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Efficacy of clobazam as add-on therapy in brain tumor-related epilepsy

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Abstract

Purpose

Brain tumor-related epilepsy (TRE) is often resistant to currently available antiepileptic medications (AEDs). Clobazam was initially approved as adjunctive AED for patients with Lennox Gastaut syndrome but has been used in TRE, despite limited evidence in this context. This observational study aims to examine the effect of clobazam on seizure frequency on patients who have a primary CNS tumor and continued seizures despite their current AEDs.

Methods

A retrospective review of patients with histologically-confirmed primary brain tumors seen in the neuro-oncology interdisciplinary clinic from April 2016–2019 was completed, and patients on clobazam were identified. Response to clobazam was defined as a greater than 50% reduction in seizure frequency. Additional data including patient and tumor characteristics, treatment course, tolerability, AEDs used prior to addition of clobazam, and AEDs concomitantly used with clobazam were collected.

Results

A total of 35 patients with TRE on clobazam were identified, with 2 patients unable to tolerate the medication due to side effects. Of the 33 remaining patients, a total of 31 (93.9%) of patients were deemed responders. Ten patients (30.3%) were seizure free within 6 months of clobazam initiation and 21 (63.6%) reported a significant reduction in seizure frequency. This reduction also allowed several patients to modify concurrent AEDs.

Conclusions

Clobazam is an effective agent to use as add-on AED in TRE, with 94% of patients showing a significant response within 6 months. Furthermore, the addition of clobazam may yield a reduction in polypharmacy, as concomitant AEDs can be reduced and potentially withdrawn.

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Acknowledgements

REDCap is supported at FSM by the Northwestern University Clinical and Translational Science (NUCATS) Institute, Research reported in this publication was supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurology, Northwestern University, Chicago, IL, USA

    Nupur Brahmbhatt, Elizabeth Bachman, Stephan U. Schuele & Jessica W. Templer

  2. Lou & Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA

    Roger Stupp & Jessica W. Templer

  3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Omar Bushara

Authors
  1. Nupur Brahmbhatt
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  2. Roger Stupp
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  3. Omar Bushara
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  4. Elizabeth Bachman
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  5. Stephan U. Schuele
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  6. Jessica W. Templer
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Correspondence to Jessica W. Templer.

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Brahmbhatt, N., Stupp, R., Bushara, O. et al. Efficacy of clobazam as add-on therapy in brain tumor-related epilepsy. J Neurooncol 151, 287–293 (2021). https://doi.org/10.1007/s11060-020-03664-9

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  • DOI: https://doi.org/10.1007/s11060-020-03664-9

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