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| |  Postoperative Seizures Occur Rarely in Patients With Low-Grade Brain Tumour Withdrawn From Antiepileptics: Presented at AES By John Otrompke BOSTON -- December 9, 2009 -- More patients who were withdrawn from antiepileptic drugs experienced epileptic seizures following surgery for low-grade brain tumours, compared with those who continued taking the drugs, according to a study presented here at the American Epilepsy Society (AES) 63rd Annual Meeting. Approximately 12% of patients who had their epilepsy drugs withdrawn after surgery experienced seizures. “Antiepilepsy medication does cause side effects, and if a patient is on chemotherapy, it can interfere with that,” said Joong Wong Lee, MD, Brigham and Women’s Hospital, Boston, Massachusetts, on December 5. However, many patients with low-grade brain tumour do not receive chemotherapy. “Because patients with low-grade brain tumours tend to live longer, medication side effects are a much bigger problem, and you have to think about taking them off the seizure medication,” said Dr. Lee, who noted that the guidelines of the American Academy of Neurology recommend that the epilepsy drugs be withdrawn. About 60% of patients with low-grade brain tumours experience seizures, said Lee, adding that the patients in the study were considered epileptic, meaning that they had experienced 2 or more seizures. “A seizure heralds the clinical onset of a brain tumour in 30% to 50% of patients,” according to lead author Elinor Artsy, Brigham and Women’s Hospital. “Low-grade gliomas and other low-growing tumours are considered the most likely cause of epilepsy.” The retrospective chart review included 115 patients who had been followed for a median of 3.1 years. The patients had low-grade brain tumours, including meningiomas, astrocytomas, oligodendrogliomas, and other mixed brain tumours. Of 97 patients with conclusive medical records, antiepileptic drugs were withdrawn or never started in 65 patients, and continued in 32 patients. If the patient experienced seizures following brain tumour surgery, the seizure medication was not withdrawn. Of the 65 patients in whom the medication was withdrawn, however, postsurgery seizures occurred in 8, compared with 14 out of 32 patients who did not have the medication withdrawn. A history of preoperative seizures, and temporal lobe location were significant predictors of postoperative seizures, but not of post-seizure medication-withdrawal seizures. “Seizures tend to occur when the tumour is located above the cerebellum, but not below the cerebellum,” Dr. Lee explained. [Presentation title: Discontinuation of Antiepileptic Drugs After Surgery in Low Grade Brain Tumors. Abstract 1.113]
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