From the Guidelines
The recommended treatment for seizures after meningioma removal is antiepileptic drugs, with levetiracetam being the first-line choice, as it has become the drug of first choice at most neuro-oncology centres in recent years 1. When considering treatment options, it's essential to weigh the benefits and risks of each medication.
- Levetiracetam is preferred due to its efficacy and relatively favorable side-effect profile, although psychiatric side-effects can be a concern in some patients 1.
- Valproic acid is still an option in some cases, given its efficacy and overall good tolerability, but it must not be used in females who may become pregnant, and interactions with other drugs need to be checked regularly 1.
- Other alternatives, such as lacosamide and lamotrigine, may be considered for patients who cannot tolerate levetiracetam or have insufficient seizure control with monotherapy 1. Treatment duration and dosage should be individualized based on the patient's response and seizure history.
- Efforts to taper and stop anticonvulsant drugs should be undertaken within weeks after surgery, provided there is no recurrent tumour growth, and the patient has achieved a near gross total resection 1.
- Patients and caregivers should be instructed on how to behave and whom to contact in case of recurrent seizures, and regular monitoring of drug levels, liver function, and complete blood counts is crucial 1.
From the FDA Drug Label
The effectiveness of levetiracetam as adjunctive therapy (added to other antiepileptic drugs) in patients with refractory partial onset seizures, with or without secondary generalization, receiving only one concomitant AED The primary measure of effectiveness was a between group comparison of the percent reduction in weekly seizure frequency relative to placebo over the entire randomized treatment period (titration + evaluation period) Secondary outcome variables included the responder rate (incidence of patients with ≥50% reduction from baseline in partial onset seizure frequency per week)
The recommended treatment for seizures after meningioma removal is not directly addressed in the provided drug labels. However, levetiracetam is shown to be effective in reducing partial onset seizure frequency in patients with refractory partial onset seizures.
- The study results show a statistically significant decrease in seizure frequency for levetiracetam-treated patients compared to placebo-treated patients.
- The responder rate (incidence of patients with ≥50% reduction from baseline in partial onset seizure frequency per week) was also higher in levetiracetam-treated patients. However, it is essential to note that the provided drug labels do not specifically address the treatment of seizures after meningioma removal. Therefore, the use of levetiracetam for this indication would be off-label 2, 2.
From the Research
Treatment of Seizures after Meningioma Removal
The treatment of seizures after meningioma removal is a critical aspect of patient care. Several studies have investigated the use of antiepileptic drugs, particularly levetiracetam, in this context.
- Levetiracetam as a Prophylactic Antiseizure Medication: A prospective randomized trial 3 found that levetiracetam did not result in significant neurotoxicity or depression when given for either 1 week or 6 weeks, with a low incidence of seizure after craniotomy for tumor resection.
- Role of Levetiracetam in Brain Tumor Patients: Levetiracetam has been proposed as an attractive option for brain tumor patients suffering from seizures, due to its lack of induction of the P450 system and minimal drug interactions 4.
- Efficacy of Levetiracetam in Reducing Seizure Frequency: A study on brain tumor patients undergoing neurosurgery found that levetiracetam monotherapy was safe and tolerable, with nearly all patients achieving a ≥50% reduction in seizure frequency post-op 5.
- Levetiracetam for Seizure Prophylaxis: A systematic review and meta-analysis 6 suggested that levetiracetam may be preferred post supratentorial neurosurgery, although more high-quality randomized trials are warranted to confirm its efficacy.
- Risk Factors for Postoperative Seizures: A retrospective study on meningioma patients 7 identified convexity location, fronto-parietal location, and preoperative seizures as risk factors for postoperative seizures, and suggested that prophylactic antiepileptic treatment might be warranted in seizure-naïve patients with ≥1 risk factor.
Key Findings
- Levetiracetam is a safe and effective option for seizure prophylaxis in patients undergoing meningioma removal.
- The duration of levetiracetam treatment may vary, with 1 week or 6 weeks being commonly used.
- Patient selection for antiepileptic drug therapy is crucial, with certain risk factors (e.g. convexity location, fronto-parietal location, preoperative seizures) increasing the likelihood of postoperative seizures.