Effectiveness of Antiseizure Medication Triple Therapy in Patients with Glioma with Refractory Epilepsy: An Observational Cohort Study

Pim B. van der Meer*, Linda Dirven, Marta Fiocco, Maaike J. Vos, Mathilde C. M. Kouwenhoven, Martin J. van den Bent, Martin J. B. Taphoorn, Johan A. F. Koekkoek

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background and ObjectivesApproximately 10% of patients with glioma with epilepsy need antiseizure medication (ASM) triple therapy due to refractory epilepsy. The aim of this study was to evaluate whether levetiracetam combined with valproic acid and clobazam (LEV + VPA + CLB), a frequently prescribed triple therapy, has favorable effectiveness compared with other triple therapy combinations in patients with glioma.MethodsThis was a multicenter retrospective observational cohort study. The primary outcome was the cumulative incidence of time to treatment failure for any reason, from the start of ASM triple therapy treatment. The secondary outcomes included cumulative incidences of the following: (1) time to treatment failure due to uncontrolled seizures; (2) time to treatment failure due to adverse effects; and (3) time to recurrent seizures. Patients were followed up for a maximum duration of 36 months.ResultsOf 1,435 patients in the original cohort, 90 patients received ASM triple therapy after second-line ASM treatment failure due to uncontrolled seizures. LEV + VPA + CLB was prescribed to 48% (43/90) and other ASM triple therapy to 52% (47/90) of patients. The cumulative incidence of treatment failure for any reason of LEV + VPA + CLB did not statistically significantly differ from that of other ASM triple therapy combinations (12 months: 47% [95% CI 31%-62%] vs 42% [95% CI 27%-56%], p = 0.892). No statistically significant differences for treatment failure due to uncontrolled seizures (12 months: 12% [95% CI 4%-25%] vs 18% [95% CI 8%-30%], p = 0.445), adverse effects (12 months: 22% [95% CI 11%-36%] vs 15% [95% CI 7%-27%], p = 0.446), or recurrent seizures (1 month: 65% [95% CI 48%-78%] vs 63% [95% CI 47%-75%], p = 0.911) were found.DiscussionLEV + VPA + CLB might show equivalent effectiveness compared with other ASM triple therapy combinations in patients with glioma.Classification of EvidenceThis study provides Class III evidence that for patients with glioma with refractory epilepsy on triple therapy ASMs, LEV + VPA + CLB demonstrated similar effectiveness and tolerability compared with other ASM triple therapy combinations.
Original languageEnglish
Pages (from-to)E1488-E1496
JournalNeurology
Volume100
Issue number14
DOIs
Publication statusPublished - 4 Apr 2023

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