Tremont-Lukats I W, Ratilal B O, Armstrong T, Gilbert M R
Louisiana State University, Neurology, 1111 Medical Center Boulevard, Suite S-750, Marrero, Louisiana 77072, USA.
Cochrane Database Syst Rev. 2008 Apr 16;2008(2):CD004424. doi: 10.1002/14651858.CD004424.pub2.
Seizures can present at any time before or after diagnosis of a brain tumor. The risk of seizures varies by tumor type and its location in the brain. For a long time we believed that preventing seizures with antiepileptic drugs (seizure prophylaxis) was effective and necessary, but the supporting evidence was little and mixed. Such evidence was the basis for previous reviews to conclude that seizure prophylaxis was ineffective in people with brain tumors.
To estimate the effectiveness of seizure prophylaxis in people with brain tumors, and to estimate the adverse event rates in the identified clinical trials.
A search strategy that included free-text and MeSH terms in LILACS, EMBASE, PubMed, CENTRAL, and The Cochrane Library (1966 to 2007).
Controlled clinical trials with random allocation, blinded or unblinded, and placebo or observation in the control groups.
We screened the articles, extracted the data, and rated the validity of each trial to assess the risk of bias. Our primary outcome was the occurrence of a first seizure. The secondary outcome was adverse events. We pooled the aggregate data for each outcome into a random-effects model meta-analysis using the relative risk (RR). For adverse events, we also included the number needed to harm (NNH) using the absolute risk increase to compute the NNH.
There was no difference between the treatment interventions and the control groups in preventing a first seizure in participants with brain tumors. The risk of an adverse event was higher for those on antiepileptic drugs than for participants not on antiepileptic drugs (NNH 3; RR 6.10, 95% CI 1.10 to 34.63; P = 0.046).
AUTHORS' CONCLUSIONS: The evidence is neutral, neither for nor against seizure prophylaxis, in people with brain tumors. These conclusions apply only for the antiepileptic drugs phenytoin, phenobarbital, and divalproex sodium. The decision to start an antiepileptic drug for seizure prophylaxis is ultimately guided by assessment of individual risk factors and careful discussion with patients.
癫痫发作可在脑肿瘤诊断之前或之后的任何时间出现。癫痫发作的风险因肿瘤类型及其在脑内的位置而异。长期以来，我们认为使用抗癫痫药物预防癫痫发作（癫痫预防）是有效且必要的，但支持证据很少且相互矛盾。这些证据是以往综述得出癫痫预防对脑肿瘤患者无效这一结论的依据。
评估癫痫预防对脑肿瘤患者的有效性，并估计已确定的临床试验中的不良事件发生率。
一种检索策略，包括在LILACS、EMBASE、PubMed、CENTRAL和Cochrane图书馆（1966年至2007年）中使用自由文本和医学主题词进行检索。
采用随机分配、设盲或不设盲、对照组使用安慰剂或观察的对照临床试验。
我们筛选文章、提取数据，并对每个试验的有效性进行评分以评估偏倚风险。我们的主要结局是首次癫痫发作的发生情况。次要结局是不良事件。我们使用相对风险（RR）将每个结局的汇总数据合并到随机效应模型的荟萃分析中。对于不良事件，我们还使用绝对风险增加来计算伤害所需人数（NNH）。
在预防脑肿瘤患者首次癫痫发作方面，治疗干预组与对照组之间没有差异。使用抗癫痫药物的患者发生不良事件的风险高于未使用抗癫痫药物的患者（NNH为3；RR为6.10，95%可信区间为1.10至34.63；P = 0.046）。
对于脑肿瘤患者，证据是中性的，既不支持也不反对癫痫预防。这些结论仅适用于抗癫痫药物苯妥英钠、苯巴比妥和丙戊酸钠。开始使用抗癫痫药物进行癫痫预防的决定最终应基于对个体风险因素的评估以及与患者的仔细讨论。
