Introduction: Prophylactic use of antiepileptic drugs (AED) in the management of seizure-naïve brain tumor patients remains a topic of debate. The aim of this study was to identify and characterize a subset of patients at highest risk for new onset perioperative seizures who may benefit from prophylactic AED.
Methods: This is a retrospective, case-controlled study of 1693 adult brain tumor patients who underwent resection or biopsy at our institution between 01/01/2004 to 06/31/2015. All patients with a history of seizures prior to surgery were excluded. Patients with posterior fossa tumors, pituitary tumors, and parasellar tumors were also excluded. The control group (group 2) was matched to seizure patients (group 1) according to age (±0 years). For each patient, demographic data, clinical status, operative data, and postoperative course data were collected and analyzed.
Results: Of the 1693 patients, 549 (32.4%) never had a seizure prior to surgery. Of the former, we identified 25 (4.5%) patients who suffered from a perioperative seizure (group 1). A total of 524 (95.5%) patients who never suffered a seizure event were matched to group 1 according to age (±0 years), resulting in 132 control patients (group 2) with an approximate ratio of 1:5. There were no differences between treatment groups in terms of age, gender, race, relationship status, and neurological deficits on presentation. Histological subtype (infiltrating gliomas vs. meningioma vs. other) (p=0.04), intra-dural location (p<0.001), phenytoin prophylaxis (p=0.0014), intraoperative cortical stimulation (p=0.044), and extent of resection (less than gross total) (p=0.002) were associated with the presence of perioperative seizures.
Conclusions: This study investigated the characteristics differentiating seizure-naive brain tumor patients who remain seizure-free and those who have new-onset perioperative seizures. Infiltrating gliomas, supratentorial intra-dural tumors, intraoperative cortical stimulation, and phenytoin prophylaxis predisposed to perioperative seizures. Gross total resection (GTR) was an important factor in reducing the risk of perioperative seizures.
Patient Care: This study provides information regarding the use of prophylactic anti-epileptic drugs (AED) in seizure-naive brain tumor patients. The findings of this study could potentially lower the use of AED by restricting therapy to seizure-naive brain tumor patients at highest risk for perioperative seizures.
Learning Objectives: 1. Understand the current literature behind seizure management in brain tumor patients
2. Describe the incidence of new-onset perioperative seizures in seizure-naïve brain tumor patients
3. Describe the characteristics placing seizure-naïve brain tumor patients at higher risk of perioperative seizures