丙戊酸钠和胶质瘤

胶质瘤病人中抗癫痫药物使用和癫痫发作

J Neurol. 2009 May 12.

Efficacy of anti-epileptic drugs in patients with gliomas and seizures.

van Breemen MS, Rijsman RM, Taphoorn MJ, Walchenbach R, Zwinkels H, Vecht CJ.上海东方医院神经外科魏社鹏

Neuro-oncology Unit, Department of Neurology, Medical Center The Hague, POB 432, 2501 CK, The Hague, The Netherlands.

作者对2000-2005年的140例脑肿瘤癫痫病人进行了分析，这其中23.6%为低度恶性胶质瘤，53.6%为高度恶性胶质瘤，22.8%为混合性的，如室管膜瘤，脑膜瘤和脑转移癌等。作者发现，和高度恶性胶质瘤病人相比，癫痫发作更常见于低度恶性胶质瘤病人(69.7 vs. 52%, P = 0.087)，有75.8%的低度恶性胶质瘤病人表现为抽风发作，80.0%的高度恶性胶质瘤病人发展为抽风发作。所有99例的抽风发作病人中，80.1%接受了丙戊酸钠作为一线用药，次选用药为左乙拉西坦，卡马西平或者拉莫三嗪。丙戊酸钠和左乙拉西坦联合使用拥有很高的有效率(81.5%)，这其中有59%的病人癫痫发作消失。丙戊酸钠的使用和生存期长短暂时并无关联。如果丙戊酸钠单用不能控制癫痫发作，则丙戊酸钠和左乙拉西坦联合使用似有更高的控制率。

Although seizures in brain tumor patients are common, the knowledge on optimal anti-seizure therapy in this patient group is limited. An observational study was carried out using a database of all patients from the neuro-oncology service during the period 2000-2005, with data on seizure characteristics, therapy with AEDs, the underlying brain tumor and its treatment. A total of 140 brain tumor patients were studied of whom 23.6% had a low-grade glioma, 53.6% a high-grade glioma, and 22.8% belonged to a mixed group existing of ependymoma, meningioma, and brain metastasis. Epilepsy as the presenting sign was more frequent in low-grade vs. high-grade gliomas (69.7 vs. 52%, P = 0.087), and a total of 75.8% of patients developed seizures with low-grade and of 80.0% with high-grade gliomas. Of all 99 patients with seizures, 80.1% received valproic acid (VPA) as first choice, and either levetiracetam (LEV), carbamazepine (CBZ) or lamotrigine (LMT) as the most frequent next choice. Patients treated with a combination of VPA and LEV showed the highest percentage of responders (81.5%), with a decline in seizure frequency of more than two categories in 55.6% and seizure freedom in 59%. No correlation was found between the use of VPA and survival. A combination of VPA and LEV seems effective, if seizure control cannot be achieved by VPA alone. This indicates that adding levetiracetam may be preferable over sequential trials of AED monotherapy in treatment-resistant seizures in patients with brain tumors.