Department of Neurology, Northwestern University, Chicago, IL, USA.
Lou & Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
J Neurooncol. 2021 Jan;151(2):287-293. doi: 10.1007/s11060-020-03664-9. Epub 2021 Jan 4.
Brain tumor-related epilepsy (TRE) is often resistant to currently available antiepileptic medications (AEDs). Clobazam was initially approved as adjunctive AED for patients with Lennox Gastaut syndrome but has been used in TRE, despite limited evidence in this context. This observational study aims to examine the effect of clobazam on seizure frequency on patients who have a primary CNS tumor and continued seizures despite their current AEDs.
A retrospective review of patients with histologically-confirmed primary brain tumors seen in the neuro-oncology interdisciplinary clinic from April 2016-2019 was completed, and patients on clobazam were identified. Response to clobazam was defined as a greater than 50% reduction in seizure frequency. Additional data including patient and tumor characteristics, treatment course, tolerability, AEDs used prior to addition of clobazam, and AEDs concomitantly used with clobazam were collected.
A total of 35 patients with TRE on clobazam were identified, with 2 patients unable to tolerate the medication due to side effects. Of the 33 remaining patients, a total of 31 (93.9%) of patients were deemed responders. Ten patients (30.3%) were seizure free within 6 months of clobazam initiation and 21 (63.6%) reported a significant reduction in seizure frequency. This reduction also allowed several patients to modify concurrent AEDs.
Clobazam is an effective agent to use as add-on AED in TRE, with 94% of patients showing a significant response within 6 months. Furthermore, the addition of clobazam may yield a reduction in polypharmacy, as concomitant AEDs can be reduced and potentially withdrawn.
脑肿瘤相关性癫痫（TRE）通常对现有的抗癫痫药物（AEDs）耐药。氯巴占最初被批准为 Lennox-Gastaut 综合征患者的辅助 AED，但已在 TRE 中使用，尽管在这种情况下证据有限。本观察性研究旨在研究氯巴占对原发性中枢神经系统肿瘤患者的疗效，这些患者在使用当前 AED 的情况下仍持续发作。
对 2016 年 4 月至 2019 年在神经肿瘤多学科诊所就诊的经组织学证实的原发性脑肿瘤患者进行了回顾性研究，并确定了使用氯巴占的患者。对氯巴占的反应定义为发作频率降低 50%以上。收集了其他数据，包括患者和肿瘤特征、治疗过程、耐受性、添加氯巴占之前使用的 AEDs 以及与氯巴占同时使用的 AEDs。
共确定了 35 例 TRE 患者使用氯巴占，有 2 例因副作用无法耐受该药物。在其余 33 例患者中，共有 31 例（93.9%）患者被认为是应答者。10 例患者（30.3%）在开始使用氯巴占后 6 个月内无癫痫发作，21 例（63.6%）报告癫痫发作频率显著降低。这种减少还使一些患者能够调整同时使用的 AED。
氯巴占是治疗 TRE 的有效辅助 AED，94%的患者在 6 个月内有显著反应。此外，添加氯巴占可能会减少多药治疗，因为可以减少并可能停用同时使用的 AED。
