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Patterns of seizure prophylaxis after oncologic neurosurgery

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Abstract

Background

Evidence supporting routine postoperative antiepileptic drug (AED) prophylaxis following oncologic neurosurgery is limited, and actual practice patterns are largely unknown beyond survey data.

Objective

To describe patterns and predictors of postoperative AED prophylaxis following intracranial tumor surgery.

Methods

The MarketScan Database was used to analyze pharmacy claims data and clinical characteristics in a national sample over a 5-year period.

Results

Among 5895 patients in the cohort, levetiracetam was the most widely used AED for prophylaxis (78.5%) followed by phenytoin (20.5%). Prophylaxis was common but highly variable for patients who underwent open resection of supratentorial intraparenchymal tumors (62.5%, reference) or meningiomas (61.9%). In multivariate analysis, biopsies were less likely to receive prophylaxis (44.8%, OR 0.47, 95% CI 0.33–0.67), and there was near consensus against prophylaxis for infratentorial (9.7%, OR 0.07, CI 0.05–0.09) and transsphenoidal procedures (0.4%, OR 0.003, CI 0.001–0.010). Primary malignancies (52.1%, reference) and secondary metastases (42.2%) were more likely to receive prophylaxis than benign tumors (23.0%, OR 0.63, CI 0.48–0.83), as were patients discharged with home services and patients in the Northeast. There was a large spike in duration of AED use at approximately 30 days.

Conclusions

Use of seizure prophylaxis following intracranial biopsies and supratentorial resections is highly variable, consistent with a lack of guidelines or consensus. Current practice patterns do not support a clear standard of care and may be driven in part by geographic variation, availability of post-discharge services, and electronic prescribing defaults rather than evidence. Given uncertainty regarding effectiveness, indications, and appropriate duration of AED prophylaxis, well-powered trials are needed.

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Funding

Dr. Wright is a consultant for Clovis Oncology and Tesaro.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA

    Brett E. Youngerman, Evan F. Joiner, Guy M. McKhann II & Jeffrey N. Bruce

  2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Xianling Wang, Jingyan Yang, Dawn L. Hershman & Alfred I. Neugut

  3. Department of Neurology, Columbia University Medical Center, New York, NY, USA

    Mary R. Welch

  4. Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA

    Mary R. Welch, Guy M. McKhann II, Jason D. Wright, Dawn L. Hershman, Alfred I. Neugut & Jeffrey N. Bruce

  5. Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA

    Jason D. Wright

  6. Department of Medicine, Columbia University Medical Center, New York, NY, USA

    Dawn L. Hershman & Alfred I. Neugut

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  1. Brett E. Youngerman
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  2. Evan F. Joiner
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  9. Alfred I. Neugut
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Correspondence to Brett E. Youngerman.

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Youngerman, B.E., Joiner, E.F., Wang, X. et al. Patterns of seizure prophylaxis after oncologic neurosurgery. J Neurooncol 146, 171–180 (2020). https://doi.org/10.1007/s11060-019-03362-1

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