P21.09 Absence of prophylactic antiepileptic drug use in high-grade glioma patients: results of a monocentric retrospective series

Abstract

Introduction: In seizure-naïve patients with high-grade gliomas (HGG), prophylactic anticonvulsants can be administered during the first postoperative week and should be discontinued thereafter. However, the sustained administration of prophylactic antiepileptic drugs (AEDs) appears to be widespread in this population. Materials And Methods: We retrospectively reviewed all adult patients with HGG who were treated in our institution between January 2008 and April 2015, and recorded information on AEDs use and epilepsy outcome. Results: 145 patients (64 females, 81 males) were included in the study. Median age was 56 years (range: 19-77) and median KPS was 80% (50-100%). Surgery consisted on complete resection in 77 patients (53%), partial resection in 54 (37%), and biopsy in 8 patients (10%). All patients were treated with first-line standard radio-chemotherapy, and 39 received additional immunotherapy with dendritic-cell vaccines. Median overall survival was 21 months. 52 patients (36%) had seizures as a presenting symptom; most of them were treated with levetiracetam and valproate (34 [65%] and 13 [25%], respectively). Among the remainder 93 patients (64%) who did not present with seizures, 13 (14%) were started on prophylactic AEDs at the Emergency Room or at other institutions, and further declined discontinuing such medications despite recommendation for doing so. Four of them (31%) had at least one seizure during the course of the disease. On the other side, 22 out of the 80 (25%) patients not receiving anticonvulsant prophylaxis suffered seizures during the course of the disease (2 of them during the first postoperative week); no differences on lobar localization of the tumor were found between patients not receiving prophylaxis who did not suffered seizures and those who did suffer seizures. Conclusions: The incidence of early postoperative seizures appears to be low among patients with HGG who do not receive primary anticonvulsant prophylaxis. Moreover, this therapeutic approach consisting on the non-administration of AED prophylaxis in such patients precludes around 75% of them from receiving unnecessary drugs.