Department of Clinical Medicine, University of Bergen, Bergen, Norway; The National Center for Epilepsy, Norway.
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Seizure. 2021 Apr;87:107-113. doi: 10.1016/j.seizure.2021.03.012. Epub 2021 Mar 15.
We investigated, whether epileptic seizures (ES) as presenting symptom in adult patients with GBM are associated with better Overall Survival (OS) compared to ES presenting later during the course of GBM, and efficacy and safety of different antiseizure medications (ASMs).
Retrospective consecutive cohort study of adults with GBM: 50 from Norway and 50 from Italy. We compared the time to changing ASM treatments. OS was investigated with a Cox regression model adjusted for time dependency.
Median follow-up was 17 months from GBM diagnosis. ES were the presenting symptom in 49 patients. All patients received ASM treatment. LEV was the first ASM in the majority of patients and the most effective at one year from the first prescription, (p = 0.004). Occurrence of adverse events (AEs) was similar between LEV and other ASMs (p = 0.47). Poorer OS correlated with older age at GBM diagnosis, country and ASM therapy. A negative impact of ASMs on OS was observed for LEV in a univariate and multivariate analysis, and for VPA (only in multivariate analysis), even when adjusted for O6-methylguanine-DNA-methyltransferase (MGMT) methylation status. Patients with ES as the onset symptom of GBM and patients who had first ES later had similar OS (p = 0.87).
ES as the GBM debut symptom did not lead to a longer OS. LEV was a more effective ASM compared to other treatments with no differences regarding AEs between LEV and other ASMs. Surprisingly, in our patients LEV and VPA were associated with worse OS than other ASMs. This result should be interpreted with caution due to the retrospective nature of this study along with the many variables which may affect the outcome in this population.
我们研究了成人 GBM 患者中以癫痫发作（ES）为首发症状是否比 GBM 病程中出现 ES 后具有更好的总生存期（OS），以及不同抗癫痫药物（ASMs）的疗效和安全性。
回顾性连续队列研究纳入成人 GBM 患者：挪威 50 例，意大利 50 例。我们比较了改变 ASM 治疗的时间。采用 Cox 回归模型调整时间依赖性来研究 OS。
中位随访时间为从 GBM 诊断后 17 个月。ES 是 49 例患者的首发症状。所有患者均接受 ASM 治疗。LEV 是大多数患者的首选 ASM，且在首次处方后一年最有效（p=0.004）。LEV 和其他 ASMs 的不良事件（AE）发生率相似（p=0.47）。OS 较差与 GBM 诊断时年龄较大、国家和 ASM 治疗相关。LEV 和 VPA（仅在多变量分析中）在单变量和多变量分析中观察到 ASM 对 OS 的负面影响，即使调整了 O6-甲基鸟嘌呤-DNA-甲基转移酶（MGMT）甲基化状态。以 ES 为 GBM 起始症状的患者和首次 ES 后出现 ES 的患者的 OS 相似（p=0.87）。
以 ES 为 GBM 首发症状不会导致更长的 OS。与其他治疗相比，LEV 是一种更有效的 ASM，LEV 与其他 ASMs 之间的 AE 无差异。令人惊讶的是，在我们的患者中，LEV 和 VPA 与其他 ASMs 相比与更差的 OS 相关。由于该研究为回顾性研究，且许多变量可能影响该人群的结局，因此应谨慎解释这一结果。
