Department of Neurology and Neurosurgery, Henry Ford Health System and Wayne State University, Detroit, Michigan, USA.
Department of Neuro-oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Neuro Oncol. 2021 Nov 2;23(11):1835-1844. doi: 10.1093/neuonc/noab152.
To update the 2000 American Academy of Neurology (AAN) practice parameter on anticonvulsant prophylaxis in patients with newly diagnosed brain tumors.
Following the 2017 AAN methodologies, a systematic literature review utilizing PubMed, EMBASE Library, Cochrane, and Web of Science databases was performed. The studies were rated based on the AAN therapeutic or causation classification of evidence (class I-IV).
Thirty-seven articles were selected for final analysis. There were limited high-level, class I studies and mostly class II and III studies. The AAN affirmed the value of these guidelines.
In patients with newly diagnosed brain tumors who have not had a seizure, clinicians should not prescribe antiepileptic drugs (AEDs) to reduce the risk of seizures (level A). In brain tumor patients undergoing surgery, there is insufficient evidence to recommend prescribing AEDs to reduce the risk of seizures in the peri- or postoperative period (level C). There is insufficient evidence to support prescribing valproic acid or levetiracetam with the intent to prolong progression-free or overall survival (level C). Physicians may consider the use of levetiracetam over older AEDs to reduce side effects (level C). There is insufficient evidence to support using tumor location, histology, grade, molecular/imaging features when deciding whether or not to prescribe prophylactic AEDs (level U).
更新 2000 年美国神经病学学会 (AAN) 关于新诊断脑肿瘤患者抗惊厥预防的实践参数。
采用 2017 年 AAN 方法，利用 PubMed、EMBASE Library、Cochrane 和 Web of Science 数据库进行系统文献回顾。根据 AAN 治疗或因果关系证据分类（I-IV 类）对研究进行评分。
最终选择了 37 篇文章进行分析。高水平、I 类研究有限，主要是 II 类和 III 类研究。AAN 肯定了这些指南的价值。
对于新诊断为脑肿瘤且未发生癫痫的患者，临床医生不应开具抗癫痫药物 (AED) 以降低癫痫发作的风险（A级）。对于正在接受手术的脑肿瘤患者，没有足够的证据推荐在围手术期或术后开具 AED 以降低癫痫发作的风险（C 级）。没有足够的证据支持开丙戊酸或左乙拉西坦以延长无进展或总生存期（C 级）。医生可以考虑使用左乙拉西坦代替旧的 AED 以减少副作用（C 级）。没有足够的证据支持根据肿瘤位置、组织学、分级、分子/影像学特征决定是否开具预防性 AED（U 级）。
