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Prophylactic antiepileptic treatment with levetiracetam for patients undergoing supratentorial brain tumor surgery: a two-center matched cohort study

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Abstract

Guidelines on the administration of prophylactic antiepileptic drugs (AED), and specifically levetiracetam, for brain tumor surgery are still lacking. In this two-center matched cohort study, we aim to compare the proportion of postoperative seizures during follow-up after supratentorial tumor surgery in patients receiving no seizure prophylaxis, and those treated with levetiracetam perioperatively. Three hundred sixteen consecutive patients undergoing supratentorial tumor surgery, without history of seizures were included: 207 patients did not receive AED (no AED group), and 109 patients received levetiracetam perioperatively (levetiracetam group). The primary outcome measure was the rate of postoperative seizures. Additionally, uni- and multivariate analyses assessing possible risk factors for postoperative seizures were performed. No statistically significant difference for the occurrence of postoperative seizures was found between the two groups (10.1%, n = 21 in the no AED group vs. 9.2%, n = 10, in the levetiracetam group; p = 0.69, OR 0.9 [0.4–2.0), NNT 103 [12.9–17.1]). After propensity score matching, the primary outcome was observed in 13 patients (12.4%) from the no AED group and in 9 patients (8.6%) from the levetiracetam group (p = 0.50, OR 0.7 [0.3–1.6], NNT 26.3 [8.3–22.4]). Among all analyzed possible risk factors for postoperative seizures, only postoperative infarction showed a statistically significant association with higher seizure rates in multivariate analysis (OR 8.2 [1.1–60.6], p = 0.04). Prophylactic treatment with levetiracetam after brain tumor surgery showed no statistically significant effect in preventing postoperative seizures. However, in case a postoperative infarction occurs, its administration might be indicated.

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Acknowledgements

We thank Sabine Schaedelin (Clinical Trials Unit, University Hospital of Basel, Switzerland) for her statistical advice.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Maria Kamenova, Raphael Guzman, Luigi Mariani & Jehuda Soleman

  2. Department of Neurosurgery, Tel Aviv Medical Center, Tel-Aviv, Israel

    Maya Stein, Zvi Ram, Rachel Grossman, Jonathan Roth & Jehuda Soleman

  3. Tel Aviv University, Tel Aviv, Israel

    Maya Stein, Zvi Ram, Rachel Grossman & Jonathan Roth

Authors
  1. Maria Kamenova
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  2. Maya Stein
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  3. Zvi Ram
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  4. Rachel Grossman
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  6. Luigi Mariani
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  8. Jehuda Soleman
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Correspondence to Maria Kamenova.

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The authors declare that there is no conflict of interest.

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The study protocol was approved by the local ethics committees (EKNZ, Basel, Switzerland and Helsinki committee, Tel Aviv, Israel).

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Patient consent was waived by the ethics committee since the study was retrospective, and based on an anonymized data registry.

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Kamenova, M., Stein, M., Ram, Z. et al. Prophylactic antiepileptic treatment with levetiracetam for patients undergoing supratentorial brain tumor surgery: a two-center matched cohort study. Neurosurg Rev 43, 709–718 (2020). https://doi.org/10.1007/s10143-019-01111-6

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  • DOI: https://doi.org/10.1007/s10143-019-01111-6

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