Do prophylactic anticonvulsants in patients with brain tumors decrease the incidence of seizures?

The well-done systematic review included a moderate number of patients from randomized controlled trials with an objective diagnosis of a brain tumor. There were mild differences between the 5 studies used in the systematic review with patients in 3 of the studies undergoing surgical resection or debulking of their disease. There was no evidence of seizure prevention overall or in the subgroup analysis. Given the small number of patients in each subgroup, these results should be interpreted with caution. Known adverse effects with anticonvulsant therapy include severe rash (including Stevens-Johnson syndrome), hematologic effects, and drug-drug interactions. Therefore, we should be hesitant to place patients on these medications without a proven benefit. The relatively small number of patients in this meta-analysis means that larger scale studies could show a small clinical benefit from anticonvulsants.