Akihiro Inoue, Makoto Ohno, Yawara Nakamura, Yoshitaka Narita, Daisuke Kawauchi, Yoshiteru Shimoda, Mitsuto Hanihara, Tomoo Matsutani, Shigeo Ohba, Natsumi Yamashita, Narushi Sugii, Kuniaki Saito, Ichiyo Shibahara, Shunsaku Takayanagi, Joji Ishida, Masamichi Takahashi, Noriyuki Kijima, Yuta Mitobe, Nayuta Higa, Masato Saito, Ryosuke Matsuda, Yukitomo Ishi, Kohei Nakajima, Shinji Yamashita, Kaoru Tamura, Iori Ozono, Taiki Setoguchi, Tetsuya Negoto, Kosuke Katayama, Atsushi Kambe, Daisuke Kuga, Kazuhiro Tanaka, Takeshi Okuda, Koichiro Sumi, Takahiro Kanda, Shigeki Takada, Kojiro Wada, Yu Fujii, Yu Kawanishi, Hideyuki Arita, Yuichi Sato, Takuya Yonemochi, Ryohei Otani, Shinichiro Koizumi, Yoshiki Arakawa, Takeharu Kunieda
LEV and PER after glioblastoma surgery were associated with a reduced risk of late seizure compared with LCM or no medication. LEV or PER may be considered as postoperative ASMs to optimize seizure control and potentially help preserve patients' QOL.
BACKGROUND: We conducted a multicenter study to investigate the utility of postoperative antiseizure medication (ASM) in the occurrence of late seizure in glioblastoma. In addition, we analyzed whether postoperative ASM affects survival.
METHODS: 1132 consecutive patients with newly diagnosed glioblastoma at 39 centers were enrolled. In patients treated with postoperative ASM (levetiracetam [LEV], lacosamide [LCM], or perampanel [PER]), as well as in those who received no medication, the cumulative incidence of late seizure, adverse events, and survival outcomes were analyzed.
RESULTS: In total, 1099 patients (female: 482, male: 617, mean age: 67.2 years) were included, among whom, 287 developed postoperative late seizure. The mean onset time of late seizure was 193.6 days after surgery. Postoperative ASMs were administered in 628 cases, LEV in 344, LCM in 124, and PER in 160. The cumulative incidence of late seizure at 12 months was as follows: no medication in 30.9%, LEV in 17.8%, LCM in 28.8%, and PER in 16.2%. Multivariable analysis disclosed that LEV and PER displayed significantly lower cumulative incidences of postoperative late seizure compared with no medication and LCM. By contrast, median progression-free survival/overall survival did not significantly differ among ASMs. However, during the 12-24 month interval, the PER group demonstrated a more favorable prognosis than the other groups.
CONCLUSIONS: LEV and PER after glioblastoma surgery were associated with a reduced risk of late seizure compared with LCM or no medication. LEV or PER may be considered as postoperative ASMs to optimize seizure control and potentially help preserve patients' QOL.