Moots P L, Maciunas R J, Eisert D R, Parker R A, Laporte K, Abou-Khalil B
Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn., USA.
Arch Neurol. 1995 Jul;52(7):717-24. doi: 10.1001/archneur.1995.00540310091021.
To describe the morbidity associated with seizures and the efficacy of anticonvulsant therapy in adult patients with malignant gliomas (MGs).
A retrospective review of charts was performed to determine the occurrence of seizures at diagnosis, the frequency and character of subsequent seizures, and the use and toxic side effects of anticonvulsants.
Sixty-five consecutive adult patients with supratentorial MGs who were examined in the neurooncology clinic at a university medical center were studied. The diagnosis was glioblastoma in 47 of the patients, and it was anaplastic astrocytoma in 18 patients. The mean age of the patients was 49.5 years. The median Karnofsky status score was 80. The median survival was 18 months.
Twenty-nine patients presented with seizures, and 21 of these had subsequent (eg, "recurrent") seizures while they were receiving anticonvulsant therapy. Ten of 36 patients who were free of seizures at diagnosis experienced seizures after diagnosis (eg, "late onset") while they were being treated with anticonvulsants, including five patients who had single seizures. Long-term seizure frequency in excess of one per month was observed in 13 patients. Ten patients had episodes of partial motor status epilepticus. Most recurrent and late-onset seizures occurred despite therapeutic anticonvulsant levels, and without evidence of tumor progression. Rash associated with anticonvulsants was observed in 26% of the patients. Other clinically important toxic side effects were observed in 14% of the patients who were receiving long-term anticonvulsant therapy.
Seizures contributed substantially to the neurologic morbidity of MGs in at least 25% of these patients. The occurrence of seizures at diagnosis was a strong predictor of subsequent seizures, and in many patients, seizures proved to be refractory to standard anticonvulsant therapy. Long-term anticonvulsant toxic side effects are relatively common in patients with MGs. The use of long-term seizure prophylaxis for patients with MGs who are free of seizures at presentation is not clearly beneficial and should be studied in a prospective trial.
描述成年恶性胶质瘤（MG）患者癫痫发作的发病率及抗惊厥治疗的疗效。
对病历进行回顾性分析，以确定诊断时癫痫发作的发生率、后续癫痫发作的频率和特征，以及抗惊厥药物的使用情况和毒副作用。
研究了在大学医学中心神经肿瘤门诊接受检查的65例连续成年幕上MG患者。其中47例患者诊断为胶质母细胞瘤，18例为间变性星形细胞瘤。患者的平均年龄为49.5岁。卡诺夫斯基状态评分中位数为80分。中位生存期为18个月。
29例患者出现癫痫发作，其中21例在接受抗惊厥治疗期间出现后续（如“复发”）癫痫发作。36例诊断时无癫痫发作的患者中有10例在接受抗惊厥治疗期间诊断后出现癫痫发作（如“迟发性”），包括5例仅发作一次的患者。13例患者观察到长期癫痫发作频率超过每月一次。10例患者出现部分运动性癫痫持续状态发作。尽管抗惊厥药物治疗水平达标，但大多数复发和迟发性癫痫发作仍会出现，且无肿瘤进展证据。26%的患者观察到与抗惊厥药物相关的皮疹。接受长期抗惊厥治疗的患者中有14%观察到其他具有临床意义的毒副作用。
癫痫发作至少在25%的这些患者中对MG的神经功能损害有很大影响。诊断时癫痫发作的发生是后续癫痫发作的有力预测指标，并且在许多患者中，癫痫发作被证明对标准抗惊厥治疗无效。长期抗惊厥药物毒副作用在MG患者中相对常见。对于就诊时无癫痫发作的MG患者，长期预防性使用抗惊厥药物的益处不明确，应在前瞻性试验中进行研究。
