Highlights
- •Seizure prevalence in patients with leptomeningeal disease (LMD) with and without brain metastases was 22%.
- •Specific tumor and treatment characteristics did not correlate with the risk of developing seizures, nor did LMD location.
- •A multivariate analysis revealed only ECOG score and treatment with systemic chemotherapy showed a significant association with survival.
- •There does not appear to be a benefit to any primary seizure prophylaxis in patients with LMD.
Abstract
Background
To determine seizure prevalence and contributing factors in patients with leptomeningeal
disease (LMD).
Methods
Authors performed a retrospective review of 79 consecutive patients with a diagnosis
of LMD. Associations between categorical variables were assessed using Chi-Square
tests or Fisher's Exact tests. Survival was plotted with Kaplan Meier curves. Variables
with a log-rank p-value of <0.20 were entered into a Cox Proportional Hazard regression
analysis.
Results
Seizure prevalence in those with and without brain metastases was 22%. Of those who
seized, 65% were admitted for this at least once while only one patient required intubation.
Primary malignancy, type or route of chemotherapy administration, form of radiation
therapy (craniospinal, focal, or whole brain), surgical treatment, location of LMD,
and number of brain metastases did not influence seizure development. Only 13% of
patients who never had seizures were on a prophylactic AED (anti-epileptic drug).
In patients who had brain metastasis, there was no significant difference in prevalence
of seizure before versus after LMD diagnosis suggesting that LMD does not significantly
increase the risk of seizure compared to brain metastasis alone. A multivariate analysis
revealed that while males trended toward inferior survival, only performance status
and treatment with systemic chemotherapy showed a significant association with survival.
Median survival time of patients after LMD diagnosis was four months.
Conclusion
The prevalence of seizure in LMD patients is 22%. There were no statistically significant
predisposing factors to seizure development. ECOG and use of systemic chemotherapy
were found to be significant prognostic factors.
Keywords
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Article Info
Publication History
Published online: May 29, 2019
Accepted:
May 28,
2019
Received in revised form:
May 6,
2019
Received:
January 24,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
