Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
J Neurooncol. 2020 Jan;146(1):171-180. doi: 10.1007/s11060-019-03362-1. Epub 2019 Dec 13.
Evidence supporting routine postoperative antiepileptic drug (AED) prophylaxis following oncologic neurosurgery is limited, and actual practice patterns are largely unknown beyond survey data.
To describe patterns and predictors of postoperative AED prophylaxis following intracranial tumor surgery.
The MarketScan Database was used to analyze pharmacy claims data and clinical characteristics in a national sample over a 5-year period.
Among 5895 patients in the cohort, levetiracetam was the most widely used AED for prophylaxis (78.5%) followed by phenytoin (20.5%). Prophylaxis was common but highly variable for patients who underwent open resection of supratentorial intraparenchymal tumors (62.5%, reference) or meningiomas (61.9%). In multivariate analysis, biopsies were less likely to receive prophylaxis (44.8%, OR 0.47, 95% CI 0.33-0.67), and there was near consensus against prophylaxis for infratentorial (9.7%, OR 0.07, CI 0.05-0.09) and transsphenoidal procedures (0.4%, OR 0.003, CI 0.001-0.010). Primary malignancies (52.1%, reference) and secondary metastases (42.2%) were more likely to receive prophylaxis than benign tumors (23.0%, OR 0.63, CI 0.48-0.83), as were patients discharged with home services and patients in the Northeast. There was a large spike in duration of AED use at approximately 30 days.
Use of seizure prophylaxis following intracranial biopsies and supratentorial resections is highly variable, consistent with a lack of guidelines or consensus. Current practice patterns do not support a clear standard of care and may be driven in part by geographic variation, availability of post-discharge services, and electronic prescribing defaults rather than evidence. Given uncertainty regarding effectiveness, indications, and appropriate duration of AED prophylaxis, well-powered trials are needed.
支持神经外科肿瘤切除术后常规应用抗癫痫药物（AED）预防的证据有限，实际的实践模式除了调查数据外还知之甚少。
描述颅内肿瘤手术后 AED 预防的模式和预测因素。
使用 MarketScan 数据库，在 5 年期间分析了全国样本中的药物治疗索赔数据和临床特征。
在队列中的 5895 名患者中，左乙拉西坦是最广泛用于预防的 AED（78.5%），其次是苯妥英（20.5%）。对于接受开颅切除幕上脑实质内肿瘤（62.5%，参照）或脑膜瘤（61.9%）的患者，预防措施很常见，但差异很大。在多变量分析中，活检不太可能接受预防措施（44.8%，OR 0.47，95%CI 0.33-0.67），对于后颅窝（9.7%，OR 0.07，CI 0.05-0.09）和经蝶窦手术（0.4%，OR 0.003，CI 0.001-0.010），几乎一致反对预防。原发性恶性肿瘤（52.1%，参照）和继发性转移（42.2%）比良性肿瘤（23.0%，OR 0.63，CI 0.48-0.83）更有可能接受预防措施，出院后有家庭服务和东北地区的患者也是如此。AED 使用的持续时间在大约 30 天时会大幅增加。
颅内活检和幕上切除术后使用抗癫痫发作预防措施的情况差异很大，这与缺乏指南或共识一致。目前的实践模式不支持明确的护理标准，部分原因可能是地理位置的差异、出院后服务的可用性以及电子处方的默认设置，而不是证据。鉴于对 AED 预防的有效性、适应症和适当持续时间存在不确定性，需要进行大规模的试验。
