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Vol. 31. Issue 6.
Pages 268-278 (November - December 2020)
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Vol. 31. Issue 6.
Pages 268-278 (November - December 2020)
Clinical Research
DOI: 10.1016/j.neucie.2020.02.004
Prophylactic anticonvulsant therapy in high-grade glioma: A systematic review and meta-analysis of longitudinal studies
Profilaxis antiepiléptica en glioma de alto grado: revisión sistemática y metaanálisis de estudios longitudinales
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Pedro David Delgado-López
Corresponding author
pedrodl@yahoo.com

Corresponding author.
, Javier Martín-Alonso
Servicio de Neurocirugía, Hospital Universitario de Burgos, Spain
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Table 1. Summary of characteristics of studies included in the metanalysis.
Table 2. Summary of adverse effects reported in the studies included in the metanalysis.
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Abstract
Introduction

It is common practice to prescribe prophylactic antiepileptic drugs (AED) to high-grade glioma (HGG) patients without a history of seizures, yet with limited evidence supporting its use. Ideally, the effectiveness of prophylactic anticonvulsants must outweigh the occurrence of adverse effects and interactions related to AED. The authors conducted a systematic review and metanalysis of longitudinal studies regarding the effectiveness of prophylactic AED in seizure-naïve HGG patients.

Materials and methods

PubMed/MEDLINE, Cochrane Central Register of Controlled trials, Embase and clinicaltrials.gov databases were systematically searched. Of the initial 1773 studies identified, 15 were finally selected for data extraction and analysis. Heterogeneity among studies, pooled hazard ratios, publication bias and sensitivity analyses were performed separately for a 15-study group (HGG patients within larger series of brain tumors) and a 6-study group (exclusively HGG patients).

Results

AED prophylaxis did not significantly reduce the incidence of postoperative seizures compared with controls, both in the 15-study group (Mantel-Haenszel random-effects pooled OR 1.08, 95% CI 0.82–1.43, 2123 patients) and in the 6-study group (pooled OR 1.22, 95% CI 0.77–1.92, 540 patients). However, some issues (paucity of prospective trials, overall moderate-risk of bias, and few studies addressing HGG patients exclusively) preclude firm conclusions against routine prophylactic AED prescription. Reported adverse effects attributable to AED were acceptable in the majority of studies.

Conclusions

Within the limitations of this review, the results of this metanalysis do not support the routine administration of prophylactic AED to HGG patients without a history of seizures.

Keywords:
High-grade glioma
Anticonvulsants
Prophylaxis
Seizures
Glioblastoma
Anaplastic astrocytoma
Antiepileptics
Resumen
Introducción

Generalmente se administran fármacos antiepilépticos (FAE) a pacientes con gliomas de alto grado (GAG) sin historia previa de crisis, a pesar de una escasa evidencia a favor. Idealmente la efectividad de la profilaxis anticomicial debe compensar la aparición de efectos adversos debidos a la medicación. Realizamos una revisión sistemática y un metaanálisis de estudios longitudinales respecto a la utilidad de los FAE en pacientes con GAG sin historia de crisis previa.

Material y métodos

Se revisaron las bases de datos PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase y clinicaltrials.gov. De los 1.773 trabajos inicialmente identificados, 15 fueron seleccionados para la extracción de datos y análisis. Se realizaron análisis de heterogeneidad, sesgo de publicación, cálculo de OR combinadas y análisis de sensibilidad, por separado, en 2 grupos: grupo de 15 estudios (pacientes con GAG incluidos en series de tumores cerebrales) y grupo de 6 estudios (exclusivamente pacientes con GAG).

Resultados

La profilaxis con FAE no redujo de forma significativa la incidencia de crisis postoperatorias respecto a los controles, tanto en el grupo-15 (OR combinada de Mantel-Haenszel, efectos aleatorios de 1,08, IC 95%: 0,82-1,43, sobre 2.123 pacientes), como en el grupo-6 (OR combinada de 1,22, IC 95% 0,77-1,92, sobre 540 pacientes). Sin embargo, la escasez de ensayos aleatorizados y de estudios con GAG exclusivamente, junto a un sesgo global moderado, impiden establecer una recomendación sólida contra la profilaxis anticomicial. Los efectos adversos atribuidos a los FAE fueron aceptables en la mayoría de los estudios.

Conclusiones

Dentro de las limitaciones de esta revisión, los resultados del metaanálisis no apoyan el uso rutinario de profilaxis antiepiléptica en pacientes con GAG sin historia previa de crisis.

Palabras clave:
Glioma de alto grado
Antiepilépticos
Profilaxis
Crisis
Glioblastoma
Astrocitoma anaplásico

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