Levetiracetam compared with valproic acid for the prevention of postoperative seizures after supratentorial tumor surgery: a retrospective chart review.

Abstract

INTRODUCTION:

Antiepileptic drugs are commonly given for perioperative prophylaxis after brain tumor surgery, and there has been growing interest in levetiracetam, a second-generation antiepileptic drug. This retrospective study compared the seizure outcomes, side effects and durability of levetiracetam with valproic acid after a craniotomy for supratentorial brain tumors.

METHODS:

Between 2009 and 2012, 282 consecutive patients with a supratentorial brain tumor underwent a craniotomy at Seoul National University Bundang Hospital. Of these patients, 51 (18.1%) and 231 (81.9%) were pre-operatively administered levetiracetam and valproic acid, respectively. The postoperative seizure outcomes (within 1 month after surgery) and the long-term side effects of both drugs were evaluated.

RESULTS:

Of the 51 patients in the levetiracetam group, 4 (7.8%) experienced postoperative seizures after brain tumor surgery, and 15 (6.5%) of the 231 patients in the valproic acid group experienced postoperative seizures (p = 0.728). The long-term complication rate of the valproic acid group (26.8%; 62/231) was significantly higher than that of the levetiracetam group (9.8%; 5/51) [p = 0.010]. In the valproic acid group, 10 hepatotoxicities, 20 hyperammonemias and 10 hematologic abnormalities (6 thrombocytopenias, 3 pancytopenias, and 1 leucopenia) occurred. Moreover, 89 patients (38.5%) in the valproic acid group changed or added other anticonvulsants because of side effects or uncontrolled seizures, whereas only 9 patients (17.6%) in the levetiracetam group changed or added other anticonvulsants (p = 0.005).

CONCLUSIONS:

The postoperative seizure control rates of levetiracetam and valproic acid were not statistically significantly different; however, levetiracetam may be superior to valproic acid in terms of its safety and durability after supratentorial tumor surgery.

• Authors: Young Jin Lee, Tackeun Kim, So Hyun Bae, Young-Hoon Kim, Jung Ho Han, Chang-Ho Yun, Chae-Yong Kim
• Journal: CNS drugs (CNS Drugs) Vol. 27 Issue 9 Pg. 753-9 (Sep 2013) ISSN: 1179-1934 [Electronic] New Zealand
• PMID: 23921717 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anticonvulsants
• Levetiracetam
• Valproic Acid
• Piracetam

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anticonvulsants (adverse effects, therapeutic use)
• Brain Neoplasms (complications, surgery)
• Child
• Child, Preschool
• Female
• Humans
• Levetiracetam
• Male
• Middle Aged
• Piracetam (adverse effects, analogs & derivatives, therapeutic use)
• Retrospective Studies
• Seizures (drug therapy, etiology, prevention & control)
• Supratentorial Neoplasms (complications, surgery)
• Treatment Outcome
• Valproic Acid (adverse effects, therapeutic use)
• Young Adult