title: A retrospective two-center study of antiepileptic prophylaxis in patients with surgically treated high-grade gliomas.
abstract: BACKGROUND
  The effectiveness of antiepileptic prophylaxis in patients with newly diagnosed high-grade glioma is debated. Craniotomy, surgical manipulation and bleeding are believed to favor the onset of seizures and, therefore, perioperative antiepileptic drugs (AEDs) are generally used. Nevertheless, evidence to initiate preoperative AED prophylaxis are weak.
  
  
  OBJECTIVE
  Aim of this paper was to evaluate the need for AED prophylaxis in surgically-treated malignant glioma patients without history of seizures.
  
  
  METHODS
  We conducted a retrospective, two-center cohort study to assess the effectiveness of preoperative AED prophylaxis. Patients were divided in two groups: one with AED preoperative administration and the other without. Because of its non-hepatic metabolism, levetiracetam (LEV) was chosen. Logistic regression models were used to investigate the odds ratio for each group. The explanatory variables included the treatment received, sex, age, and site of lesion. The outcome measure of successful LEV prophylaxis was seizure vs. no seizure post-operatively, at three and six months after surgery.
  
  
  RESULTS
  Our results showed that LEV prophylaxis was not a significant predictor of seizure occurrence, although the regression coefficient indicated a slight reduction in seizure risk following LEV administration. Patient's age was a significant predictor of seizure occurrence. Younger patients had a higher risk of seizure in the six months post-surgery.
  
  
  CONCLUSIONS
  We conclude that AEDs prophylaxis does not provide a substantial benefit to surgically treated high-grade glioma patients and should not be administered routinely. Further investigations are required to detect subgroups of patients at higher risk of developing seizures in order to selectively administer AED.
authors: Department of Neuroscience, University of Brescia, Brescia, Italy.
authors: Diego
authors: D
authors: Garbossa
authors: Pier Paolo
authors: PP
authors: Panciani
authors: Romina
authors: R
authors: Angeleri
authors: Luigi
authors: L
authors: Battaglia
authors: Fulvio
authors: F
authors: Tartara
authors: Marco
authors: M
authors: Ajello
authors: Alessandro
authors: A
authors: Agnoletti
authors: Pietro
authors: P
authors: Versari
authors: Alessandro
authors: A
authors: Ducati
authors: Marco
authors: M
authors: Fontanella
authors: Giannantonio
authors: G
authors: Spena
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000150:complications* / Q000601:surgery; D003399:Craniotomy; D005260:Female; D005910:Glioma / Q000150:complications* / Q000601:surgery; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D010889:Piracetam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011184:Postoperative Period; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam