Authors: Herbert B Newton Jennifer Dalton Samuel Goldlust Dennis Pearl
Publish Date: 2007/04/13
Volume: 84, Issue: 3, Pages: 293-296
Abstract
Seizures are a common complication of metastatic brain tumors MBT affecting approximately 27–50 of all patients during the course of their illness Treatment of tumorinduced seizures is often inadequate with traditional antiepileptic drugs AED due to a variety of factors including activation of glutamatergic NMDA receptors alterations of neuronal input pathways and tumor growth Levetiracetam LEV is a 2nd generation nonenzyme inducing AED with a novel mechanism of action binding to neuronal synaptic vesicle protein SV2A that has been previously shown to reduce seizure activity in patients with primary brain tumors Due to its unique mechanism of action it has been postulated that LEV may also be effective in controlling seizures from MBT A retrospective chart review was performed of all NeuroOncology Center patients with MBT who had received LEV for seizure control Thirteen patients were reviewed with a median age of 551 years range 34–70 Six patients had breast cancer five had lung cancer and two had melanoma LEV was used as an addon AED in seven patients 54 and as monotherapy in six patients 46 with a median dose of 1000 mg/day range 500–3000 The baseline median seizure frequency was one ictal event every other day After the addition of LEV the median seizure frequency was reduced to 0 per week The seizure frequency was reduced to less than 50 of the preLEV baseline in 100 of patients P = 00002 Sign test with 10 patients 77 confidence interval 46–95 noting complete seizure control The most common adverse event was somnolence and headache noted in 3 of 13 patients 23 LEV was very effective and well tolerated in MBT patients with seizures and should be considered for addon therapy or as a substitute AED for monotherapy
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