JOURNAL READING

EFFICACY OF ANTI-EPILEPTIC
DRUGS IN PATIENTS WITH
GLIOMAS AND SEIZURES
Seizures in brain tumors are common

Clinical studies on epilepsy in gliomas and

the effects of anti-seizure therapy are
limited
 Objectives
Learn more about the
frequency of seizures and on
the effects of anti-epileptic
drugs (AEDs) in brain tumor
Studying the efficacy of
levetiracetam in brain tumor

Compared the survival of brain

tumor with or without VPA
• Database collected from 1 July 2000 - 2005
• All patients attending brain tumor clinic
• Medical files, baseline characteristics and
survival data were collected
• Categories of brain tumor were grouped:
1. Low-grade gliomas
2. High-grade gliomas
3. Other brain tumors
• 5 categories of seizure frequency were
distinguished
• Each time an AED was added or discontinued
the frequency of seizures was scored
• 4 types of AEDs were distinguished to study
effect on epilepsy frequency
• Survival of brain tumor (with and without
VPA) and minimal follow-up of 6 months were
compared
• Descriptive statistics and statistical evaluation
using Chi-square test or Mann-Whitney U test
• P values <0.05 considered to be statistically
significant
• Kaplan-Meyer survival uses to show survival of
patients
• Log rank test was used to determine possible
effect on survival time
 DISCUSSION

• Patients treated with the combination of VPA

and LEV, indicate a good response to this drug
combination
• Adjunctive therapy of LEV might be the next
step if initial monotherapy fails in patients
with partial seizures
• Add-on levetiracetam might be more effective
than monotherapy with levetiracetam
 DISCUSSION

• VPA can interact with anti-cancer agents via its

enzyme-inhibiting effect on the P-450
cytochrome system in the liver, thereby
increasing the possibility of toxic levels of
concomitantly given agents
• VPA has the potential of apoptosis, growth
arrest, and cell differentiation of cancer cells
through inhibition of histone deacetylase
 DISCUSSION

• Survival in the largest group of patients with

the least censored patients with a GBM, there
is a trend but no significant effect of VPA on
longer survival.
 CONCLUSION

• Combination of VPA and LEV in treating

seizures in brain tumor patients seems
to be effective, if seizures cannot be
controlled with VPA alone
• Adding levetiracetam may be preferable
over sequential trials of AED
monotherapy in treatment-resistant
epilepsy in patients with brain tumors
TERIMA KASIH
 CRITICAL APPRAISAL

No Item 2 1 NA
Result
1. Is the risk per unit time of the outcome event(s) given √
2. Is the risk of clinical importance √
3. Is the estimate of risk sufficiency precise
Validity
4. Was the phase of disease well defined √
5. Were patients at a uniform point in this phase √
6. Was the referral pattern described √
Follow up
7. Was follow up sufficiently complete √
8. Were the outcome measurement objective √
9. Was outcome assessment blind √
 CRITICAL APPRAISAL
No Item 2 1 NA
Statistical analysis
10. Were additional prognostic factor allowed for √
11. Was validation of the prognostic factor performed √
12. Were there reasonable numbers of events √
13. Were appropriate methods used √
14. Were unusual methods justified √
Utility
15. Do the result help me choose the treatments √
16. Do the result help me reassure/counsel patients √
TOTAL (Add ringed scores above) 31 (A)
No of questions which actually applied to this article(max 17) 16 (B)
Maximum possible score (2xB) 32 (C)
Overall rating (A/C expressed as a percentaged) 96.87