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Add-on Gabapentin for Refractory Seizures in Patients With Brain Tumours

Published online by Cambridge University Press:  18 September 2015

James R. Perry  and
Carol Sawka
James R. Perry*
Affiliation:
Divisions of Neurology and Medical Oncology, Sunnybrook Health Science Centre, University of Toronto, and the Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ontario
Carol Sawka*
Affiliation:
Divisions of Neurology and Medical Oncology, Sunnybrook Health Science Centre, University of Toronto, and the Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ontario
*
PO Box 3963, Neuro-Oncology Section, Division of Neurology, Duke University Medical Center. Durham, North Carolina USA 27710
PO Box 3963, Neuro-Oncology Section, Division of Neurology, Duke University Medical Center. Durham, North Carolina USA 27710
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Abstract:

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Background: Seizures associated with intracranial neoplasms are occasionally refractory to conventional anti-epileptic drugs. Gabapentin (GBP) is one of several novel anti-epileptic drugs effective as an add-on therapy for intractable seizures but has not been studied in patients with cerebral tumours. Patients and Methods: We used GBP in a open-label add-on fashion to treat 14 patients with intractable seizures associated with intracranial tumours including four glioblastomas, four metastases, three recurrent glioblastomas, and one each of anaplastic and low grade astrocytoma and meningioma. GBP was added if optimization of pre-existing therapy failed and was titrated until seizures were controlled. Results: One patient experienced adverse drowsiness. Follow-up ranged from 3–24 weeks during which time 7 patients died from disease progression. Concurrent therapy included dexamethasone in eight, cranial irradiation in four, and radiosurgery in one. Responder rate (number with at least 50% fewer seizures) was. 100% and persisted throughout follow-up. Complete resolution of seizures occurred in 8/14 patients. Conclusions: GBP was well tolerated in patients with brain tumours. Seizure frequency was reduced in all patients and efficacy persisted over time; however, the mechanism of this improvement is unclear. Concurrent therapy, regression of frequency to the mean, and the lack of controls may account for apparent benefit. In addition, because GBP may interact with a leucine-related neuronal binding site we also speculate that this novel mechanism of action may have been enhanced in our patients due to the abnormal blood-brain barrier associated with cerebral tumours. Further investigation and a controlled trial are warranted.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 23 , Issue 2 , February 1996 , pp. 128 - 131
Copyright
Copyright © Canadian Neurological Sciences Federation 1996

References

1.Agbi, CB, Bernstein, M.Seizure prophylaxis for brain tumour patients. Can Fam Phys 1993; 39: 1153–1164.Google ScholarPubMed
2.Ramsey, RE.Clinical efficacy and safety of gabapentin. Neurology 1994; 44 (Suppl. 5): 523–530.Google Scholar
3.Penfield, W, Erickson, TC, Tarlov, I.Relation of intracranial tumours and symptomatic epilepsy. Arch Neurol Psychiatr (Chicago) 1940; 44:300–315.CrossRefGoogle Scholar
4.Ramamurthi, B, Ravi, R, Ramachandran, V.Convulsions and meningiomas: incidence and significance. Surg Neurol 1980; 14: 415–416.Google ScholarPubMed
5.Shaw, MDM.Post-operative epilepsy and the efficacy of anticonvulsant therapy. Acta Neurochirurgica 1990; 50: 55–57.Google ScholarPubMed
6.Lund, M.Epilepsy in association with intracranial tumours. Acta Psychol Neurol Scand 1952; 8: 1–49.Google Scholar
7.Youmans, JR, Cobb, CA.Glial and neuronal tumours of the brain in adults. In: Youmans, JR, ed. Neurological Surgery. Philadelphia: WB Saunders Co., 1982.Google Scholar
8.Mahaley, MS Jr., Dudka, L.The role of anticonvulsant medications in the management of patients with anaplastic gliomas. Surg Neurol 1981; 16:399–401.CrossRefGoogle ScholarPubMed
9.Franceschetti, S, Binelli, S, Casazza, M, et al. Influence of surgery and antiepileptic drugs on seizures symptomatic of cerebral tumours. Acta Neurochir 1990; 103: 47–51.CrossRefGoogle ScholarPubMed
10.Cohen, N, Strauss, G, Lew, R, et al. Should prophylactic anticonvulsants be administered to patients with newly-diagnosed cerebral metastases? A retrospective analysis. J Clin Oncol 1988; 6: 1621–1624.CrossRefGoogle ScholarPubMed
11.McKenzie, SW, Laperriere, N, Bernstein, M.The effect of brachytherapy on seizure activity in brain tumour patients. Presented at the fifth Canadian Neuro-oncology meeting, Huntsville, Ontario, June 1992.Google Scholar
12.Cascino, GD, Kelly, PJ, Hirschorn, KA, et al. Stereotactic resection of intra-axial cerebral lesions in partial epilepsy. Mayo Clin Proc 1990; 65: 1053–1060.CrossRefGoogle ScholarPubMed
13.Morris, HH, Estes, ML.Brain tumours and chronic epilepsy. In: Wyllie, E, ed. The Treatment of Epilepsy: Principles and Practice. Philadelphia: Lea and Febiger, 1993.Google Scholar
14.Vickrey, BG, Hays, RD, Engel, J Jr. Outcome assessment for epilepsy surgery: the impact of measuring health-related quality of life. Ann Neurol 1995; 37: 158–160.CrossRefGoogle ScholarPubMed
15.Perry, JR.Adjuvant chemotherapy for malignant astrocytoma: analysis of methodologic issues and outcome data from randomized controlled trials. Neurology 1995; 45 (Suppl. 4): 386–387(abs).Google Scholar
16.Weitzner, MA, Meyers, CA, Gelke, CK, et al. The Functional Assessment of Cancer Therapy (FACT) scale. Development of a brain subscale and revalidation of the general version (FACT-G) in patients with primary brain tumours. Cancer 1995; 75: 1151–1161.3.0.CO;2-Q>CrossRefGoogle Scholar
17.Mattson, RH.Selection of drugs for the treatment of epilepsy. Semin Neurol 1990; 10: 406–413.CrossRefGoogle ScholarPubMed
18.Lee, S-T, Lui, T-N, Chang, C-N, et al. Prophylactic anticonvulsants for prevention of immediate and early postcraniotomy seizures. Surg Neurol 1989; 31: 361–364.CrossRefGoogle ScholarPubMed
19.Deutchsmann, CS, Haines, SJ.Anticonvulsant prophylaxis in neurological surgery. Neurosurgery 1985; 17: 510–517.Google Scholar
20.DeAngelis, LM.Management of brain metastases. Cancer Invest 1994; 12: 156–165.CrossRefGoogle ScholarPubMed
21.McLean, MJ.Clinical pharmacokinetics of gabapentin. Neurology 1994; 44 (Suppl. 5): 517–522.Google ScholarPubMed
22.Taylor, CP.Emerging perspectives on the mechanism of action of gabapentin. Neurology 1994; 44 (Suppl. 5): 510–516.Google ScholarPubMed
23.Rogers, LR, Morris, HH, Lupica, K.Effect of cranial irradiation on seizure frequency in adults with low grade astrocytoma and medically intractable epilepsy. Neurology 1993; 43: 1599–1601.CrossRefGoogle ScholarPubMed
24.Bruner, JM.Neuropathology of malignant gliomas. Semin Oncol 1994; 21: 126–138.Google ScholarPubMed
25.Schnabel, R, Rambeck, B, May, TW, et al. Concentrations of carbamazepine and carbamazepine-10, 11-epoxide in serum, brain tumours and paratumourous cortex: a prospective study of 37 neurosurgically treated epileptic patients. Eur Neurol 1994; 34: 213–220.CrossRefGoogle Scholar
26.Guyatt, GH, Keller, JL, Jaeschke, R, et al. The n-of-1 randomized controlled trial: clinical usefulness. Ann Intern Med 1990; 112: 293–299.CrossRefGoogle ScholarPubMed