Neurology: Observational Study on the Effect of Levetiracetam Use Time on the Overall Survival Rate of Adult Isocitrate Dehydrogenase Wild-type Glioblastoma

Glioblastoma, especially isocitrate dehydrogenase (IDH) type 1 and 2-wild type, is the most common primary malignant brain tumor in adults
.

Where feasible, the maximum safe resection, then standard radiotherapy and chemotherapy combined with temozolomide is the recommended first-line treatment

Glioblastoma, especially isocitrate dehydrogenase (IDH) type 1 and 2-wild type, is the most common primary malignant brain tumor in adults

Seizuresat the time of diagnosis are a predictor of longer survival for patients with diffuse glioma .
This clinical observation seems to be contradictory, because epilepsy and diffuse glioma have a common pathogenic mechanism and influence each other .
In addition, neuronal activity has been shown to promote the growth of gliomas .
The first hypothesis is that less aggressive diffuse gliomas-expected to survive longer-may be more conducive to the development of the epileptic process, which requires surviving neurons and plasticity .
Another explanation is that drug treatments for common pathogenic mechanisms may affect seizure and tumor control at the same time .
Studies have shown that several anti-epileptic drugs, mainly sodium valproate, levetiracetam and peracetam, have anti-tumor effects, and temozolomide chemotherapy can improve epilepsy control .
In IDH-wild-type glioblastoma patients, the incidence of seizures is as high as 30-60%, requiring long-term use of anti-epileptic drugs .
Therefore, anti-epileptic drugs are often used in combination .
Levetiracetam (mainly for synaptic vesicle protein 2A) has been increasingly used as the first antiepileptic drug for the treatment of glioma-related epilepsy .
Seizures caused by its high therapeutic index, favorable pharmacokinetics, non-interaction with chemotherapy drugs, tolerance and antiemetic effect .
The first hypothesis for diagnosing epilepsy is that less aggressive diffuse gliomas-expected to survive longer-may be more conducive to the development of the epileptic process, which requires surviving neurons and plasticity

Previous studies have shown that the relationship between the use of levetiracetam and the improvement of the survival rate of glioblastoma patients during the standard combination chemotherapy and radiotherapy regimen and the combination of temozolomide has conflicting results

Observational single-institution cohort study (2010-2018)
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The inclusion criteria were: 1) patients ≥ 18 years old; 2) newly diagnosed supratentorial tumors; 3) histo-molecular diagnosis of IDH-wild-type glioblastoma; 4) standard radiotherapy and chemotherapy regimens

     Observational single-institution cohort study (2010-2018)

• Include 460 patients
  .
  
  Throughout the standard chemotherapy regimen, the median overall survival of 116 patients who used levetiracetam (21.
  0 months; 95% CI, 17.
  2-24.
  0) was higher than that of 126 patients who used levetiracetam concurrently.
  Patients (16.
  8 months; 95% CI, 12.
  4-19.
  
       The use of levetiracetam in the entire standard radiotherapy and chemotherapy regimen may improve the overall survival rate of IDH-wild-type glioblastoma patients
  
  Source: Pallud J, Huberfeld G, Dezamis E, et al.
  Effect of Levetiracetam Use Duration on Overall Survival of Isocitrate Dehydrogenase Wildtype Glioblastoma in Adults: An Observational Study [published online ahead of print, 2021 Oct 21].
  Neurology.
  2021; 10.
  1212/WNL.
  0000000000013005.
  doi:10.
  1212/WNL.
  0000000000013005 Literature source: Pallud J, Huberfeld G, Dezamis E, et al.
  Effect of Levetiracetam Use Duration on Overall Survival of Isocitrate Dehydrogenase Wildtype Glioblastoma in Adults: An Observational Study [published online ahead of print, 2021 Oct 21].
  Neurology.
  2021;10.
  1212/WNL.
  0000000000013005.
  doi:10.
  1212/WNL.
  0000000000013005Pallud J, Huberfeld G, Dezamis E, et al.
  Effect of Levetiracetam Use Duration on Overall Survival of Isocitrate Dehydrogenase Wildtype Glioblastoma in Adults: An Observational Study [published online ahead of print, 2021 Oct 21].
  Neurology.
  2021;10.
  1212/WNL .
  0000000000013005.
  doi:10.
  1212/WNL.
  0000000000013005 Pallud J, Huberfeld G, Dezamis E, et al.
  Effect of Levetiracetam Use Duration on Overall Survival of Isocitrate Dehydrogenase Wildtype Glioblastoma in Adults: An Observational Study [published online ahead of print, 2021 Oct .
  .
  .
  21] Neurology 2021; 10.
  1212 / WNL.
  0000000000013005 doi: 10.
  1212 / WNL.
  0000000000013005 in this message