Temporal Trend in Postoperative Seizure Prophylaxis Use in Glioma Patients (P3.128)

OBJECTIVE: To characterize practice patterns regarding long-term seizure prophylaxis in gliomas over the last 7 years at our institution. BACKGROUND: In 2000, the AAN practice parameter stated that first generation long-term prophylactic antiepileptic drugs (AEDs) should not be routinely used in newly diagnosed brain tumors. North American data up to 2005 reported deviation from these guidelines. Since then, practice patterns have not been reassessed. DESIGN/METHODS: A retrospective chart review was performed on 578 glioma cases evaluated in a single tertiary care center from 2006-2013. Demographics, tumor characteristics, surgical procedure, seizure rate, and AED(s) use were recorded. Long-term prophylactic AED use was defined as continued use at 3 months post-surgery in the absence of seizures. Patients were divided into three groups at surgery: seizure-free with and without prophylactic AEDs, and seizure-patients. Cox Regression survival analysis was performed on each group. RESULTS: Of 578 patients operated between 2006-2013, 330(57.1[percnt]) were seizure-naive pre-operatively. Of these 330, 205(62.1[percnt]) received prophylactic AED at surgery. 96/205(46.9[percnt]) were still on AED 3 months post-surgery (median use=58 days; 95[percnt]CI(31-152)). Rate of long-term prophylaxis use decreased by only 13.5[percnt] over 6 years (70.3[percnt]-2006; 56.8[percnt]-2012). Phenytoin was the preferred agent in 2006(98.2[percnt]) with increasing use of levetiracetam over years (2[percnt]-2008; 44.6[percnt]-2012). The only predictive factor for prophylaxis use was complete resection (p=0.007, OR=2.0292, 95[percnt]CI(1.2202, 3.4177)). First seizure rate was similar in both seizure-free populations (p=0.910, HR=0.9627, 95[percnt]CI(0.5153, 1.806)). Seizure-population survived longer than seizure-free populations (p=0.004, HR=0.56, 95[percnt]CI(0.3805,0.8298)), with age and complete resection mainly influencing survival (p’s<0.0001). CONCLUSIONS: From 2006 to 2013, most of our patients were maintained on long-term prophylactic AED, suggesting minimal change in practice pattern since published 2000 guidelines. Corrective measures are hence necessary. An increase in new generation AEDs use for seizure prophylaxis was noted, which may warrant a critical appraisal of recent evidence with these newer AEDs to update guidelines. Disclosure: Dr. Lapointe has nothing to disclose. Dr. Florescu has received personal compensation for activities with Eli Lilly & Company. Dr. Djeffal has nothing to disclose. Dr. Belanger has nothing to disclose. Dr. Nguyen has nothing to disclose.