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Perioperative levetiracetam for prevention of seizures in supratentorial brain tumor surgery

  • Clinical Study – Patient Study
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An Erratum to this article was published on 23 July 2010

Abstract

Efficacy and tolerability of levetiracetam (LEV) as perioperative seizure prophylaxis in supratentorial brain tumor patients were retrospectively studied. Between February 2007 and April 2009 in a single institution, 78 patients with primary or secondary supratentorial brain tumors [40 female, 38 male; mean age 57 years, from 27 to 89 years; gliomas in 42 patients (53.8%), brain metastases in 17 (21.8%), meningiomas in 16 (20.5%), 1 primary central nervous system (CNS) lymphoma patient, and 2 patients with radiation necrosis] received between 1,000 mg and 3,000 mg LEV perioperatively. Preoperatively, 30 patients had experienced seizures (38.5%), most commonly glioma patients (47.6%), but also meningioma patients (31.3%) or patients with brain metastases (23.5%). No more seizures occurred in patients receiving 1–3 g LEV preoperatively. Within the first week postoperatively, a single seizure occurred in two patients (2.6%). At the end of the follow-up period (mean 10.5 months, range 0–31 months), 71 of the 78 patients (91%) were seizure free and 21 (26%) patients were not taking antiepileptic drugs. We observed side-effects in five patients (6.4%), including non-tumor-associated progressive somnolence in three patients (1.5 g, 1.5 g, and 2 g LEV daily) and reactive psychosis in two patients (1 and 1.5 g LEV daily), regressing after dose reduction. Perioperative LEV in supratentorial brain tumor patients was well tolerated. Compared with the literature, it resulted in low (2.5%) seizure frequency in the early postoperative period. Additionally, its advantage of lacking cytochrome P450 enzyme induction allowed early initiation of effective postoperative chemotherapy in malignant glioma patients.

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Abbreviations

AED:

Antiepileptic drug

CBZ:

Carbamazepine

CNS:

Central nervous system

CYP:

Cytochrome P450

EEG:

Electroencephalography

FU:

Follow-up

GM:

Grand mal

LEV:

Levetiracetam

OXC:

Oxcarbazepine

PB:

Phenobarbital

PHT:

Phenytoin

POD:

Postoperative day

VPA:

Valproic acid

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Authors and Affiliations

  1. Department of Neurosurgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria

    Iris Zachenhofer, Markus Donat & Karl Roessler

  2. Department of Neurology and LBI for Neurooncology, Kaiser Franz Josef Hospital, SMZ-Süd, Vienna, Austria

    Stefan Oberndorfer

Authors
  1. Iris Zachenhofer
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  2. Markus Donat
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  3. Stefan Oberndorfer
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  4. Karl Roessler
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Correspondence to Iris Zachenhofer.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s11060-010-0298-2

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Zachenhofer, I., Donat, M., Oberndorfer, S. et al. Perioperative levetiracetam for prevention of seizures in supratentorial brain tumor surgery. J Neurooncol 101, 101–106 (2011). https://doi.org/10.1007/s11060-010-0235-4

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  • DOI: https://doi.org/10.1007/s11060-010-0235-4

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