Optimizing antiseizure medication treatment in glioma patients with epilepsy

Meer, P.B. van der (2023)

Doctoral Thesis

The aim of this thesis was to assess the efficacy (part 1) and tolerability (part 2) of antiseizure medications (ASMs) in glioma patients with epilepsy. In addition, we aimed to get insight into the ASM prescription behavior and treatment policy in brain tumor-related epilepsy (part 3).
First-line levetiracetam seems to be the most efficacious ASM in glioma patients, with favourable tolerability. This is demonstrated in multicenter retrospective observational cohort studies, a systematic review, and is the opinion among the vast majority of European neuro-oncology professionals. Enzyme-inducing AMSs should be avoided in glioma patients due to the high risk of adverse effects. ASM use was not independently associated with neuropsychiatric symptoms in glioma patients, but alternative factors seem to pose a greater risk for developing neuropsychiatric symptoms. If patients experience uncontrolled seizures on ASM monotherapy, levetiracetam combined with valproic acid has better efficacy than other ASM combinations in glioma patients, while toxicity is similar. Subsequently, potential add-on ASMs in glioma patients experiencing uncontrolled seizures on ASM dual therapy include clobazam, lamotrigine, and lacosamide.

• Brain tumor
• Glioma
• Epilepsy
• Seizures
• Antiepileptic drugs
• Valproic acid
• Levetiracetam
• Depression
• Anxiety
• Cognition

• All authors: Meer, P.B. van der
• Supervisor: Taphoorn, M.J.B.
• Co-supervisor: Koekkoek, J.A.F.; Dirven, L.
• Committee: Fiocco, M.; Gerven, J.M.A. van; Bent, M.J. van den; Witt Hamer, P.V. de; Majoie, H.J.M.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2023-11-02
• ISBN (print): 9789464695199
• Sponsorship: UCB Pharma; Eisai Co., Ltd.; Stichting Neuro-Oncologie; St. Jacobusstichting