Department of Pharmacy, Methodist University Hospital, 1265 Union Ave, Memphis, TN 38104, USA.
J Neurooncol. 2010 Sep;99(2):251-60. doi: 10.1007/s11060-010-0126-8. Epub 2010 Feb 10.
To determine the safety and tolerability of IV and oral levetiracetam monotherapy for seizures in brain tumor patients following resection. Brain tumor patients undergoing neurosurgery with >or=1 seizure within the preceding month prior to surgery were enrolled to receive intravenous levetiracetam for a minimum of 48 h, transitioned to oral levetiracetam at the same dose, and followed for 1-month after discharge. Patients were assessed daily in the hospital, provided with a seizure diary, and supplied with 30 days of levetiracetam upon discharge. Study patients were telephoned weekly to assess their cognitive status and seizure frequency. Of the 17 patients enrolled, the baseline seizure types were tonic clonic, partial, and complex partial with secondary generalization. The most common type of tumor was glioblastoma multiforme. Levetiracetam was well tolerated with no medication discontinuation during the study period. Adverse effects reported were somnolence, nausea/vomiting, headache, and insomnia. Eleven patients were evaluable for TICS scores (64.7%) with an average score of 33.3. Two patients were deemed to be cognitively impaired (18.2%). Eleven of twelve patients (91.7%) that completed the study period achieved a >or=50% reduction in their number of seizures. A total of 92 drug interactions were avoided (P = 0.0016) with dexamethasone, acetaminophen, and fentanyl being the most common. Levetiracetam monotherapy was found to be safe and tolerable in this patient population. Nearly all patients achieved a >or=50% reduction in seizure frequency post-op with levetiracetam monotherapy. Levetiracetam also has the potential for less drug interactions compared to phenytoin in these patients.
评估脑肿瘤切除术后患者接受静脉注射和口服左乙拉西坦单药治疗的安全性和耐受性。对术前一个月内至少发作一次癫痫的脑肿瘤患者行神经外科手术，患者先接受至少 48 小时的静脉左乙拉西坦治疗，然后过渡到相同剂量的口服左乙拉西坦，并在出院后随访 1 个月。患者在住院期间每天接受评估，提供癫痫日记，并在出院时提供 30 天的左乙拉西坦。研究患者每周通过电话评估认知状态和癫痫发作频率。17 例入组患者的基线癫痫发作类型为强直阵挛性、部分性和复杂部分性伴继发全面性发作。最常见的肿瘤类型为多形性胶质母细胞瘤。左乙拉西坦的耐受性良好，在研究期间无药物停药。报告的不良反应有嗜睡、恶心/呕吐、头痛和失眠。11 例患者可评估 TICS 评分（64.7%），平均得分为 33.3。有 2 例患者被认为认知受损（18.2%）。完成研究期的 11 例患者（91.7%）中有 11 例癫痫发作次数减少了 ≥50%。避免了 92 种药物相互作用（P=0.0016），其中地塞米松、对乙酰氨基酚和芬太尼最常见。在该患者人群中，左乙拉西坦单药治疗被发现是安全且耐受良好的。几乎所有患者在术后接受左乙拉西坦单药治疗后癫痫发作频率均减少了≥50%。与苯妥英钠相比，左乙拉西坦在这些患者中也具有潜在的更少的药物相互作用。
