Practice parameter: Anticonvulsant prophylaxis in patients with newly diagnosed brain tumors [RETIRED]

TLDR

Patients with primary or metastatic brain tumors experience a high seizure incidence (20–40 % at diagnosis) and face significant anticonv.

Abstract

Overview.The Quality Standards Subcommittee seeks to develop scientifically sound, clinically relevant practice parameters for the practice of neurology.Practice parameters are strategies for patient management that assist physicians in clinical decision making.A practice parameter is one or more specific recommendations based on analysis of evidence on a specific clinical problem.These might include diagnosis, symptoms, treatment, or procedure evaluation.American Academy of Neurology (AAN) members have requested the publication of a practice parameter on the use of prophylactic anticonvulsants in patients with primary and metastatic brain tumors.Justification. ][3][4] If anticonvulsant medications were free of side effects, their prophylactic use might be attractive even without such evidence.However, discomfort, expense, and inconvenience result from drug treatment and periodic monitoring of serum drug concentrations.Typical anticonvulsant-induced side effects, including cognitive impairment, myelosuppression, liver dysfunction, and dermatologic reactions (ranging from minor rashes to life-threatening Stevens-Johnson syndrome), appear to occur more frequently in patients with brain tumors than in other patient groups, 3,[5][6][7][8][9][10][11][12][13][14][15][16] although direct comparison studies have not been published.A spectrum of side effects unique to patients with brain tumors must also be considered.Phenytoin, carbamazepine, and phenobarbital reduce the efficacy of corticosteroids, [17][18][19][20][21] which are administered almost universally to brain tumor patients.3][24][25][26][27][28][29][30][31][32][33][34] As a result, inadequate chemotherapeutic dosing of brain tumor patients has been identified recently as a widespread and critically important problem. 351][52] Twenty to 40% of all brain tumor patients have experienced a seizure by the time their brain tumor is diagnosed. 3,4,11,12,[14][15][16[53][54][55][56][57][58][59][60][61] In these patients, the need for anticonvulsant medication is clear.[14][15][16][57][58][59][60][61] Because the number of newly diagnosed brain tumor patients is increasing yearly, 62-65 the question of whether to administer prophylactic anticonvulsants is being posed to neurologists with increasing frequency by their patients and by colleagues in neurosurgery, internal medicine, oncology, and radiation oncology.Although a number of studies have attempted to answer this question, 3,[11][12][13][14][56][57][58][59][60][66][67][68] these studies have used differing epidemiologic techniques, patient populations, treatment regimens, and outcome measures, and there remains no consensus among physicians about the optimum approach to this problem. Currently, he decision to administer