title: Antiepileptic drugs for treating seizures in adults with brain tumours.
abstract: BACKGROUND
  Seizures are a common symptom of brain tumours. The mainstay of treatment for seizures is medical therapy with antiepileptic drugs.
  
  
  OBJECTIVE
  To evaluate the relative effectiveness and tolerability of antiepileptic drugs commonly used to treat seizures in adults with brain tumours.
  
  
  METHODS
  We searched CENTRAL (Issue 2 of 4, The Cochrane Library 2011), MEDLINE (1948 to May week 3, 2011) and EMBASE (1980 to 31 May 2011) databases. In addition, we handsearched articles published since 2000 in the following journals selected by the authors: Epilepsia; The Lancet Neurology and Neuro-Oncology.
  
  
  METHODS
  Controlled clinical trials with random allocation of the use of antiepileptic drugs to treat seizures in adults with brain tumours.
  
  
  METHODS
  Both review authors screened the search results and reviewed the abstracts of potentially relevant articles before retrieving the full text of eligible articles.
  
  
  RESULTS
  Only one trial met the inclusion criteria for this review which was a small, open-label, unblinded, randomised trial of the safety and feasibility of switching from phenytoin to levetiracetam monotherapy or continuing phenytoin for glioma-related seizure control following craniotomy (Lim 2009). Levetiracetam (a non enzyme-inducing antiepileptic drug) appears to have been at least as well tolerated and as effective as phenytoin (an enzyme-inducing antiepileptic drug) for the treatment of seizures in people with brain tumours. Eighty-seven per cent of participants treated with levetiracetam were free of seizures at six months compared with 75% of participants treated with phenytoin. There is one ongoing study of levetiracetam versus pregabalin for the treatment of seizures in adults undergoing chemotherapy, radiotherapy,or both for primary brain tumours. No data from this study were available at the time of preparing this review.
  
  
  CONCLUSIONS
  There is a lack of robust, randomised, controlled evidence to support the choice of antiepileptic drug for the treatment of seizures in adults with brain tumours. While some authors support the use of non enzyme-inducing antiepileptic drugs, reliable, comparative evidence to provide clinical justification for this is limited. There is a need for further large, randomised, controlled trials in this area.
authors.affiliation: Edinburgh Centre for Neuro-Oncology (ECNO), Western General Hospital, Crewe Road, Edinburgh, Scotland, UK, EH4 2XU.
authors.forename: Simon
authors.initials: S
authors.lastname: Kerrigan
authors.forename: Robin
authors.initials: R
authors.lastname: Grant
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000150:complications*; D057915:Drug Substitution; D006801:Humans; D000077287:Levetiracetam; D010672:Phenytoin / Q000627:therapeutic use; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012640:Seizures / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010672:Phenytoin; D010889:Piracetam