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Seizure prophylaxis and melanoma brain metastases

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Abstract

Melanoma has a high propensity to metastasize to the brain. In patients with brain metastases (BM) survival is limited, neurologic morbidity is high, with seizure incidence reported up to 67%. Current guidelines recommend against antiepileptic drug prophylaxis (AED PPX) in patients without a history of seizure. We reviewed our experience with melanoma BM to determine the efficacy of AED PPX in the era of second generation AED and to delineate risk factors associated with development of seizures. We reviewed records of all patients treated at Memorial Sloan-Kettering Cancer Center with melanoma and BM between May 2006 and October 2008. Seizure risk was studied relative to BM characteristics at diagnosis and AED PPX. We identified 109 patients. Median age was 61 years (range 29–91); 56% had no neurologic symptoms at diagnosis. On neuroimaging, 94% (102/109) had cortical lesions, 60% (65/109) had more than one supratentorial lesion, 54% (59/109) had hemorrhage. Seizure led to diagnosis of BM in 13% (14/109); 20% (22/109) developed seizures later. On univariate analysis among patients without a seizure at diagnosis, AED-PPX was significantly associated with decreased risk of seizure (P = 0.03) with 3-month seizure rate of 0% compared to 17% without AED-PPX. Hemorrhage (P < 0.001) and multiple supratentorial metastases (P = 0.03) were associated with increased seizure risk. Melanoma patients with multiple supratentorial BM and hemorrhage may have an increased risk of seizure. AED PPX may be effective in selected patients, and should be addressed in a randomized controlled trial.

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Acknowledgments

Dr. Avila had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of interest

There was no financial sponsorship for this study. Dr. Goldlust reports no conflicts of interest. In the last 2 years, Dr. Lassman served on scientific advisory boards (with associated travel) and/or consulted for Campus Bio, Eisai, Genentech, GlaxoSmithKline, Merck, and Schering-Plough; received honoraria for speaking and associated travel from Schering-Plough/Merck; and receives research support from Keryx Biopharmaceuticals, Schering-Plough/Merck, Genentech, National Brain Tumor Society, Voices Against Brain Cancer, Dana Foundation, Brain Tumor Funders’ Collaborative, the Radiation Therapy Oncology Group, and NIH grant UO1-CA069856. Ms. Hsu reports no conflicts of interest. Dr. Panageas reports no conflicts of interest. Dr. Avila reports no conflicts of interest.

IRB approval

IRB approval was obtained by the Memorial Sloan-Kettering institutional review board. The methods section of the manuscript reports this approval.

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Author notes

  1. S. A. Goldlust

    Present address: Hackensack University Medical Center, Hackensack, NJ, USA

Authors and Affiliations

  1. Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    S. A. Goldlust & E. K. Avila

  2. Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    M. Hsu & K. S. Panageas

  3. The Brain Tumor Center, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    S. A. Goldlust & E. K. Avila

  4. Department of Neurology, Columbia University Medical Center, The Neurological Institute of New York, 710 West 168th Street, New York, NY, 10032-3784, USA

    A. B. Lassman

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  1. S. A. Goldlust
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  2. M. Hsu
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Correspondence to E. K. Avila.

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Goldlust, S.A., Hsu, M., Lassman, A.B. et al. Seizure prophylaxis and melanoma brain metastases. J Neurooncol 108, 109–114 (2012). https://doi.org/10.1007/s11060-012-0802-y

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  • DOI: https://doi.org/10.1007/s11060-012-0802-y

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