Sirven Joseph I, Wingerchuk Dean M, Drazkowski Joseph F, Lyons Mark K, Zimmerman Richard S
Department of Neurology Mayo Clinic College of Medicine, Scottsdale, Ariz, USA.
Mayo Clin Proc. 2004 Dec;79(12):1489-94. doi: 10.4065/79.12.1489.
To assess whether antiepileptic drugs (AEDs) should be prescribed to patients with brain tumors who have no history of seizures.
We performed a meta-analysis of randomized controlled trials (1966-2004) that evaluated the efficacy of AED prophylaxis vs no treatment or placebo to prevent seizures in patients with brain tumors who had no history of epilepsy. Summary odds ratios (ORs) were calculated using a random-effects model. Three subanalyses were performed to assess pooled ORs of seizures in patients with primary glial tumors, cerebral metastases, and meningiomas.
Of 474 articles found in the initial search, 17 were identified as primary studies. Five trials met inclusion criteria: patients with a neoplasm (primary glial tumors, cerebral metastases, and meningiomas) but no history of epilepsy who were randomized to either an AED or placebo. The 3 AEDs studied were phenobarbital, phenytoin, and valproic acid. Of the 5 trials, 4 showed no statistical benefit of seizure prophylaxis with an AED. Meta-analysis confirmed the lack of AED benefit at 1 week (OR, 0.91; 95% confidence interval [CI], 0.45-1.83) and at 6 months (OR, 1.01; 95% CI, 0.51-1.98) of follow-up. The AEDs had no effect on seizure prevention for specific tumor pathology, including primary glial tumors (OR, 3.46; 95% CI, 0.32-37.47), cerebral metastases (OR, 2.50; 95% CI, 0.25-24.72), and meningiomas (OR, 0.62; 95% CI, 0.10-3.85).
No evidence supports AED prophylaxis with phenobarbital, phenytoin, or valproic acid in patients with brain tumors and no history of seizures, regardless of neoplastic type. Subspecialists who treat patients with brain tumors need more education on this issue. Future randomized controlled trials should address whether any of the newer AEDs are useful for seizure prophylaxis.
评估对于无癫痫发作史的脑肿瘤患者是否应开具抗癫痫药物（AEDs）。
我们对1966年至2004年的随机对照试验进行了荟萃分析，这些试验评估了AED预防与不治疗或安慰剂相比，对无癫痫病史的脑肿瘤患者预防癫痫发作的疗效。使用随机效应模型计算汇总比值比（ORs）。进行了三项亚分析，以评估原发性胶质瘤、脑转移瘤和脑膜瘤患者癫痫发作的汇总ORs。
在初始检索中找到的474篇文章中，17篇被确定为主要研究。五项试验符合纳入标准：患有肿瘤（原发性胶质瘤、脑转移瘤和脑膜瘤）但无癫痫病史的患者被随机分为AED组或安慰剂组。所研究的三种AED分别为苯巴比妥、苯妥英和丙戊酸。在这五项试验中，四项显示AED预防癫痫发作无统计学益处。荟萃分析证实，在随访1周时（OR，0.91；95%置信区间[CI]，0.45 - 1.83）和6个月时（OR，1.01；95%CI，0.51 - 1.98），AED无益处。AED对特定肿瘤病理类型的癫痫预防无作用，包括原发性胶质瘤（OR，3.46；95%CI，0.32 - 37.47）、脑转移瘤（OR，2.50；95%CI，0.25 - 24.72）和脑膜瘤（OR，0.62；95%CI，0.10 - 3.85）。
无论肿瘤类型如何，均无证据支持对无癫痫发作史的脑肿瘤患者使用苯巴比妥、苯妥英或丙戊酸进行AED预防。治疗脑肿瘤患者的专科医生需要在这个问题上接受更多教育。未来的随机对照试验应探讨任何一种新型AED是否对癫痫预防有用。
