Kerrigan Simon, Grant Robin
Edinburgh Centre for Neuro-Oncology (ECNO), Western General Hospital, Crewe Road, Edinburgh, Scotland, UK, EH4 2XU.
Cochrane Database Syst Rev. 2011 Aug 10;2011(8):CD008586. doi: 10.1002/14651858.CD008586.pub2.
Seizures are a common symptom of brain tumours. The mainstay of treatment for seizures is medical therapy with antiepileptic drugs.
To evaluate the relative effectiveness and tolerability of antiepileptic drugs commonly used to treat seizures in adults with brain tumours.
We searched CENTRAL (Issue 2 of 4, The Cochrane Library 2011), MEDLINE (1948 to May week 3, 2011) and EMBASE (1980 to 31 May 2011) databases. In addition, we handsearched articles published since 2000 in the following journals selected by the authors: Epilepsia; The Lancet Neurology and Neuro-Oncology.
Controlled clinical trials with random allocation of the use of antiepileptic drugs to treat seizures in adults with brain tumours.
Both review authors screened the search results and reviewed the abstracts of potentially relevant articles before retrieving the full text of eligible articles.
Only one trial met the inclusion criteria for this review which was a small, open-label, unblinded, randomised trial of the safety and feasibility of switching from phenytoin to levetiracetam monotherapy or continuing phenytoin for glioma-related seizure control following craniotomy (Lim 2009). Levetiracetam (a non enzyme-inducing antiepileptic drug) appears to have been at least as well tolerated and as effective as phenytoin (an enzyme-inducing antiepileptic drug) for the treatment of seizures in people with brain tumours. Eighty-seven per cent of participants treated with levetiracetam were free of seizures at six months compared with 75% of participants treated with phenytoin. There is one ongoing study of levetiracetam versus pregabalin for the treatment of seizures in adults undergoing chemotherapy, radiotherapy,or both for primary brain tumours. No data from this study were available at the time of preparing this review.
AUTHORS' CONCLUSIONS: There is a lack of robust, randomised, controlled evidence to support the choice of antiepileptic drug for the treatment of seizures in adults with brain tumours. While some authors support the use of non enzyme-inducing antiepileptic drugs, reliable, comparative evidence to provide clinical justification for this is limited. There is a need for further large, randomised, controlled trials in this area.
癫痫发作是脑肿瘤的常见症状。癫痫治疗的主要方法是使用抗癫痫药物进行药物治疗。
评估常用于治疗成人脑肿瘤癫痫发作的抗癫痫药物的相对有效性和耐受性。
我们检索了Cochrane中心对照试验注册库（2011年第2期，第4卷，Cochrane图书馆）、MEDLINE数据库（1948年至2011年5月第3周）和EMBASE数据库（1980年至2011年5月31日）。此外，我们还手工检索了作者选择的以下期刊自2000年以来发表的文章：《癫痫》；《柳叶刀神经病学》和《神经肿瘤学》。
采用随机分配抗癫痫药物治疗成人脑肿瘤癫痫发作的对照临床试验。
两位综述作者筛选了检索结果，并在获取符合条件文章的全文之前，对潜在相关文章的摘要进行了审查。
只有一项试验符合本综述的纳入标准，这是一项小型、开放标签、非盲法的随机试验，研究开颅术后从苯妥英钠转换为左乙拉西坦单药治疗或继续使用苯妥英钠治疗胶质瘤相关癫痫发作的安全性和可行性（Lim 2009）。左乙拉西坦（一种非酶诱导性抗癫痫药物）在治疗脑肿瘤患者的癫痫发作方面，似乎至少与苯妥英钠（一种酶诱导性抗癫痫药物）耐受性相当且效果相同。接受左乙拉西坦治疗的参与者中，87%在6个月时无癫痫发作，而接受苯妥英钠治疗的参与者中这一比例为75%。有一项正在进行的关于左乙拉西坦与普瑞巴林治疗原发性脑肿瘤接受化疗、放疗或两者兼有的成人癫痫发作的研究。在撰写本综述时，尚未获得该研究的数据。
缺乏有力的随机对照证据来支持选择抗癫痫药物治疗成人脑肿瘤癫痫发作。虽然一些作者支持使用非酶诱导性抗癫痫药物，但提供临床依据的可靠比较证据有限。该领域需要进一步开展大型随机对照试验。
