title: Prophylactic antiepileptic drug administration following brain tumor resection: results of a recent AANS/CNS Section on Tumors survey.
abstract: OBJECTIVE Antiepileptic drugs (AEDs) are often administered prophylactically following brain tumor resection. With conflicting evidence and unestablished guidelines, however, the nature of this practice among tumor surgeons is unknown. METHODS On November 24, 2015, a REDCap (Research Electronic Database Capture) survey was sent to members of the AANS/CNS Section on Tumors to query practice patterns. RESULTS Responses were received from 144 individuals, including 18.8% of board-certified neurosurgeons surveyed (across 86 institutions, 16 countries, and 5 continents). The majority reported practicing in an academic setting (85%) as a tumor specialist (71%). Sixty-three percent reported always or almost always prescribing AED prophylaxis postoperatively in patients with a supratentorial brain tumor without a prior seizure history. Meanwhile, 9% prescribed occasionally and 28% rarely prescribed AED prophylaxis. The most common agent was levetiracetam (85%). The duration of seizure prophylaxis varied widely: 25% of surgeons administered prophylaxis for 7 days, 16% for 2 weeks, 21% for 2 to 6 weeks, and 13% for longer than 6 weeks. Most surgeons (61%) believed that tumor pathology influences epileptogenicity, with high-grade glioma (39%), low-grade glioma (31%), and metastases (24%) carrying the greatest seizure risk. While the majority used prophylaxis, 62% did not believe or were unsure if prophylactic AEDs reduced seizures postoperatively. The vast majority (82%) stated that a well-designed randomized trial would help guide their future clinical decision making. CONCLUSIONS Wide knowledge and practice gaps exist regarding the frequency, duration, and setting of AED prophylaxis for seizure-naive patients undergoing brain tumor resection. Acceptance of universal practice guidelines on this topic is unlikely until higher-level evidence supporting or refuting the value of modern seizure prophylaxis is demonstrated.
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Dewan
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Reid C
authors.initials: RC
authors.lastname: Thompson
authors.affiliation: Department of Neurological Surgery, Henry Ford Health System, Detroit, Michigan.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Kalkanis
authors.affiliation: Department of Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts; and.
authors.forename: Fred G
authors.initials: FG
authors.lastname: Barker
authors.affiliation: Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Constantinos G
authors.initials: CG
authors.lastname: Hadjipanayis
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D001921:Brain / Q000601:surgery*; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D005910:Glioma / Q000601:surgery*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures; D011182:Postoperative Care; D011184:Postoperative Period; D010818:Practice Patterns, Physicians'; D012640:Seizures / Q000517:prevention & control*
chemical_list: D000927:Anticonvulsants
keywords: AANS = American Association of Neurological Surgeons; AED = antiepileptic drug; CNS = Congress of Neurological Surgeons; REDCap = Research Electronic Data Capture; brain tumor; epilepsy; levetiracetam; oncology; prophylaxis; survey