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Antiepileptics in brain metastases: safety, efficacy and impact on life expectancy

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Abstract

The aim of the study was to evaluate efficacy, safety and impact on life expectancy of levetiracetam (LEV), oxcarbazepine (OXC) and topiramate (TPM) monotherapy in patients with seizures related to brain metastases. We conducted a prospective observational study on 70 patients with brain metastases. Thirteen patients were excluded because they were in prophylactic therapy with antiepileptics, nine patients did not return to our Center. A total of 48 patients with epilepsy related to brain metastases were enrolled. Patients were treated with LEV, OXC and TPM in monotherapy and followed until their death. Eighteen patients dropped out. Therefore, we followed 30 patients. Mean duration of follow-up was 6.1 months. Upon visiting the patients prior to their death (i.e. last visit preceding the death of the patients), we observed a significant reduction (P < 0.001) in the mean monthly seizure frequency; with 19 patients (63.3%) obtaining complete seizure control in the whole population. A significant improvement of seizure frequency was also observed considering each antiepileptic treatment group separately. Median survival time was similar among the three groups of patients and was similar to Class I of prognostic factors of Radiation Therapy Oncology Group. Logistic regression showed that systemic treatments did not influence the antiepileptics’ efficacy on seizure control (P = 0.614). In conclusion, regarding the use of newer antiepileptics in patients with seizures related to brain metastases, our data indicate that LEV, OXC and TPM significantly reduce seizure frequency (independently of systemic treatment), produce few side effects and appear not to affect life expectancy.

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Acknowledgements

The authors wish to express their gratitude to Ms. Lesley Pritikin for reviewing the manuscript.

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Authors and Affiliations

  1. Center for Tumor-Related Epilepsy, Department of Neuroscience and Cervical-Facial Pathology, National Institute for Cancer “Regina Elena”, Via Elio Chianesi 53, 00144, Rome, Italy

    M. Maschio, L. Dinapoli & B. Jandolo

  2. Department of Radiotherapy, National Institute for Cancer “Regina Elena”, Via Elio Chianesi 53, 00144, Rome, Italy

    S. Gomellini

  3. Department of Oncology, National Institute for Cancer “Regina Elena”, Via Elio Chianesi 53, 00144, Rome, Italy

    V. Ferraresi

  4. Department of Epidemiology, National Institute for Cancer “Regina Elena”, Via Elio Chianesi 53, 00144, Rome, Italy

    F. Sperati

  5. Department of Radiology, National Institute for Cancer “Regina Elena”, Via Elio Chianesi 53, 00144, Rome, Italy

    A. Vidiri

  6. Scientific Direction, National Institute for Cancer “Regina Elena”, Via Elio Chianesi 53, 00144, Rome, Italy

    P. Muti

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  1. M. Maschio
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  2. L. Dinapoli
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  3. S. Gomellini
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  4. V. Ferraresi
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  5. F. Sperati
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  6. A. Vidiri
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  7. P. Muti
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  8. B. Jandolo
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Correspondence to M. Maschio.

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Maschio, M., Dinapoli, L., Gomellini, S. et al. Antiepileptics in brain metastases: safety, efficacy and impact on life expectancy. J Neurooncol 98, 109–116 (2010). https://doi.org/10.1007/s11060-009-0069-0

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  • DOI: https://doi.org/10.1007/s11060-009-0069-0

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