Brain tumor location influences the onset of acute psychiatric adverse events of levetiracetam therapy: an observational study.
To explore possible correlations among brain lesion location, development of psychiatric symptoms and the use of antiepileptic drugs (AEDs) in a population of patients with brain tumor and epilepsy. The medical records of 283 patients with various types of brain tumor (161 M/122 F, mean age 64.9 years) were analysed retrospectively. Patients with grade III and IV glioma, previous history of epileptic seizures and/or psychiatric disorders were excluded. Psychiatric symptoms occurring after initiation of AED therapy were considered as treatment emergent psychiatric adverse events (TE-PAEs) if they fulfilled the following conditions: (1) onset within 4 weeks after the beginning of AED therapy; (2) disappearance on drug discontinuation; (3) absence of any other identified possible concurrent cause. The possible influence of the following variables were analysed: (a) AED drug and dose; (b) location and neuroradiologic features of the tumor, (c) location and type of EEG epileptic abnormalities, (d) tumor excision already or not yet performed; (e) initiation or not of radiotherapy. TE-PAEs occurred in 27 of the 175 AED-treated patients (15.4%). Multivariate analysis showed a significant association of TE-PAEs occurrence with location of the tumor in the frontal lobe (Odds ratio: 5.56; 95% confidence interval 1.95-15.82; p value: 0.005) and treatment with levetiracetam (Odds ratio: 3.61; 95% confidence interval 1.48-8.2; p value: 0.001). Drug-unrelated acute psychiatric symptoms were observed in 4 of the 108 AED-untreated patients (3.7%) and in 7 of the 175 AED-treated patients (4%). The results of the present study suggest that an AED alternative to levetiracetam should be chosen to treat epileptic seizures in patients with a brain tumor located in the frontal lobe to minimize the possible onset of TE-PAEs.
Neurology Unit, S. Anna Hospital, Como, Italy. vincenzobelcastro@libero.it.
Vincenzo
http://orcid.org/0000-0002-3416-2900
V
Belcastro
Neurology Unit, "Cutrona Zodda" Hospital, Barcellona Pozzo di Gotto, ME, Italy.
Laura Rosa
LR
Pisani
Neurosurgery Unit, S. Anna Hospital, Como, Italy.
Silvio
S
Bellocchi
Neurosurgery Unit, S. Anna Hospital, Como, Italy.
Paolo
P
Casiraghi
Neurology Unit, S. Giovanni di Dio Hospital, Crotone, Italy.
Gaetano
G
Gorgone
Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals, NHS Foundation Trust and Institute of Medical and Biomedical Sciences, St George's University of London, London, UK.
Marco
M
Mula
Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy.
Francesco
F
Pisani
D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects*; D001932:Brain Neoplasms / Q000139:chemically induced* / Q000145:classification / Q000188:drug therapy / Q000473:pathology*; D015331:Cohort Studies; D004569:Electroencephalography; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced* / Q000473:pathology*; D008875:Middle Aged; D010889:Piracetam / Q000009:adverse effects / Q000031:analogs & derivatives*; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve
D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam
Epilepsy; Levetiracetam; Psychiatric adverse events; Tumor frontal lobe location