Advertisement

Journal of Neuro-Oncology

, Volume 74, Issue 2, pp 211–215 | Cite as

Results of a Survey of Neurosurgical Practice Patterns Regarding the Prophylactic use of Anti-Epilepsy Drugs in Patients with Brain Tumors

  • Vitaly Siomin
  • Lilyana Angelov
  • Liang Li
  • Michael A. Vogelbaum
Clinical Study

Summary

Introduction: The American Association of Neurology issued guidelines discouraging the prophylactic use of anti-epilepsy drugs (AEDs) in patients with brain tumors. We surveyed neurosurgeons to evaluate practice patterns with regard to using AEDs in neurosurgical patients with brain tumors. Methods: The survey consisted of 18 questions. Two group email blasts containing an internet link to the survey were sent to members of the American Association of Neurological Surgeons with email addresses. Uni- and multi-variate analysis of the responses was performed using t-test, Fisher’s exact test, or chi-squared test, where appropriate. Results: The response rate was 15.5% (386/2491). The majority of respondents (270/386; 70.0%) had more than 5 years of experience in neurosurgery. Most respondents described their practices as general (224/379; 59.1%); about one-third were members of the Joint Section on Tumors (136/381; 35.7%). More than 70% of respondents reported routine use of AED prophylaxis for patients with intra-axial gliomas or brain metastases. AED prophylaxis was also routinely used for extra-axial benign tumors or stereotactic biopsies by 53.8% and 21.4%, respectively. On multivariate analysis, the number of years in practice of ABNS certified neurosurgeons was the strongest predictor for the use of AED prophylaxis. Conclusions: Routine use of AED prophylaxis in patients with brain tumors undergoing neurosurgical procedures remains the prevailing practice pattern among members of the AANS. Additional larger prospective studies with appropriate patient stratification culminating in development of neurosurgical guidelines on AED prophylaxis in brain tumor patients is warranted.

Keywords

anti-epileptic drugs brain tumors prophylactic practice patterns 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Boarini, DJ, Beck, DW, VanGilder, JC 1985Postoperative prophylactic anticonvulsant therapy in cerebral gliomasNeurosurgery16290292PubMedGoogle Scholar
  2. 2.
    Cohen, N, Strauss, G, Lew, R, Silver, D, Recht, L 1988Should prophylactic anticonvulsants be administered to patients with newly-diagnosed cerebral metastases? A retrospective analysisJ Clin Oncol616211624PubMedGoogle Scholar
  3. 3.
    Forsyth, PA, Weaver, S, Fulton, D, Brasher, PM, Sutherland, G, Stewart, D, Hagen, NA, Barnes, P, Cairncross, JG, DeAngelis, LM 2003Prophylactic anticonvulsants in patients with brain tumourCan J Neurol Sci30106112PubMedGoogle Scholar
  4. 4.
    Franceschetti, S, Binelli, S, Casazza, M, Lodrini, S, Panzica, F, Pluchino, F, Solero, CL, Avanzini, G 1990Influence of surgery and antiepileptic drugs on seizures symptomatic of cerebral tumoursActa Neurochir1034751CrossRefGoogle Scholar
  5. 5.
    Glantz, MJ, Cole, BF, Friedberg, MH, Lathi, E, Choy, H, Furie, K, Akerley, W, Wahlberg, L, Lekos, A, Louis, S 1996A randomized, blinded, placebo-controlled trial of divalproex sodium prophylaxis in adults with newly diagnosed brain tumorsNeurology46985991PubMedGoogle Scholar
  6. 6.
    Mahaley, MS,Jr, Dudka, L 1981The role of anticonvulsant medications in the management of patients with anaplastic gliomasSurg Neurol16399401CrossRefPubMedGoogle Scholar
  7. 7.
    Moots, PL, Maciunas, RJ, Eisert, DR, Parker, RA, Laporte, K, Abou-Khalil, B 1995The course of seizure disorders in patients with malignant gliomasArch Neurol52717724PubMedGoogle Scholar
  8. 8.
    De Santis, A, Villani, R, Sinisi, M, Stocchetti, N, Perucca, E 2002Add-on phenytoin fails to prevent early seizures after surgery for supratentorial brain tumors: a randomized controlled studyEpilepsia43175182CrossRefPubMedGoogle Scholar
  9. 9.
    Foy, PM, Chadwick, DW, Rajgopalan, N, Johnson, AL, Shaw, MD 1992Do prophylactic anticonvulsant drugs alter the pattern of seizures after craniotomyJ Neurol Neurosurg Psychiatry55753757PubMedGoogle Scholar
  10. 10.
    Lee, ST, Lui, TN, Chang, CN, Cheng, WC, Wang, DJ, Heimburger, RF, Lin, CG 1989Prophylactic anticonvulsants for prevention of immediate and early postcraniotomy seizuresSurg Neurol31361364CrossRefPubMedGoogle Scholar
  11. 11.
    Temkin, NR 2002Prophylactic Anticonvulsants After NeurosurgeryEpilepsy Curr2105107CrossRefPubMedGoogle Scholar
  12. 12.
    Glantz, MJ, Cole, BF, Forsyth, PA, Recht, LD, Wen, PY, Chamberlain, MC, Grossman, SA, Cairncross, JG 2000Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumorsReport of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology5418861893Google Scholar
  13. 13.
    Adams, AS, Soumerai, SB, Lomas, J, Ross-Degnan, D 1999Evidence of self-report bias in assessing adherence to guidelinesInt J Qual Health Care11187192ReviewCrossRefPubMedGoogle Scholar
  14. 14.
    Eccles, M, Ford, GA, Duggan, S, Steen, N 1999Are postal questionnaire surveys of reported activity valid? An exploration using general practitioner management of hypertension in older peopleBr J Gen Pract493538PubMedGoogle Scholar
  15. 15.
    Brouwers, MC, Chambers, A, Perry, J 2003Neuro-oncology Disease Site GroupCan surveying practitioners about their practices help identify priority clinical practice guideline topics? BMC Health Serv Res323Google Scholar
  16. 16.
    The Brain Trauma Foundation, The American Association of Neurological Surgeons2000The Joint Section on Neurotrauma and Critical Care: Role of antiseizure prophylaxis following head injuryJ Neurotrauma17549553ReviewGoogle Scholar
  17. 17.
    Council National Health and Medical Research: A guide to the development, implementation and evaluation of clinical practice guidelines. (Edited by: AusInfo). Australia 1999Google Scholar
  18. 18.
    Berger, MS, Ghatan, S, Haglund, MM, Dobbins, J, Ojemann, GA 1993Low-grade gliomas associated with intractable epilepsy: seizure outcome utilizing electrocorticography during tumor resectionJ Neurosurg796269PubMedGoogle Scholar
  19. 19.
    Deutschman, CS, Haines, SJ 1985Anticonvulsant prophylaxis in neurological surgeryNeurosurgery17510517PubMedGoogle Scholar
  20. 20.
    Gilles, FH, Sobel, E, Leviton, A, Hedley-Whyte, ET, Tavare, CJ, Adelman, LS, Sobel, RA 1992Epidemiology of seizures in children with brain tumors. The Childhood Brain Tumor ConsortiumJ Neurooncol125368CrossRefPubMedGoogle Scholar
  21. 21.
    Glantz, MJ, Recht, L 1997Epilepsy in the cancer patientVinken, PJBruyn, GW eds. Neuro-oncology Part. III. Neurological disorders in systemic cancer. Handbook of clinival neurology, Vol 69Elsevier PublishingAmsterdamm918Google Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Vitaly Siomin
    • 1
  • Lilyana Angelov
    • 1
  • Liang Li
    • 2
  • Michael A. Vogelbaum
    • 1
  1. 1.Department of NeurosurgeryThe Cleveland Clinic Brain Tumor InstituteClevelandUSA
  2. 2.Department of Biostatistics and EpidemiologyBrain Tumor Institute Cleveland Clinic FoundationClevelandUSA

Personalised recommendations