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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Leptomeningeal metastasis.Handb. Clin. Neurol. 2018; 149: 169-204https://doi.org/10.1016/B978-0-12-811161-1.00013-X
- Leptomeningeal metastasis of primary central nervous system (CNS) neoplasms.Cancer Treat. Res. 2005; 125: 71-85
- Leptomeningeal metastases.Soc. Neurol. Oncol. 2002; 16: 375-394
- Brain tumor related epilepsy.Curr. Neuropharmacol. 2012; 10: 124-133https://doi.org/10.2174/157015912800604470
- Phenytoin and postoperative epilepsy: a double blind study.J. Neurosurg. 1983; 58: 672-677
- Influence of surgery and antiepileptic drugs on seizures symptomatic of cerebral tumours.Acta Neurochir. 1990; 103: 47-51
- A randomized, blinded, placebo-controlled trial of divalproex sodium prophylaxis in adults with newly diagnosed brain tumours.Neurol. 1996; 46: 985-991
- Prophylactic anticonvulsants in patients with brain tumor.Can. J. Neurol. Sci. 2003; 30: 106-112
- Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors.Am. Acad. Neurol. 2000; 54: 1886-1893https://doi.org/10.1212/WNL.54.10.1886
- A meta-analysis: do prophylactic antiepileptic drugs in patients with brain tumors decrease the incidence of seizures?.Clin. Neurol. Neurosurg. 2015; 134: 98-103https://doi.org/10.1016/j.clineuro.2015.04.010
- Treating seizures in patients with brain tumors: drug interactions between antiepileptic and chemotherapeutic agents.Semin. Oncol. 2003; 30 (Suppl 19): 49-52
- Clinical outcome and prognostic analysis of meningeal carcinomatosis treated by intrathecal chemotherapy.Expert Rev. Pharmacoecon. Outcomes Res. 2018; 18: 455-460https://doi.org/10.1080/14737167.2018.1467269
- Leptomeningeal carcinomatosis: presenting and prognostic factors.Arch. Neurol. 1996; 53: 626-632
- Prognostic factors and clinical outcomes in patients with leptomeningeal metastasis from solid tumors.J. Neuro-Oncol. 2008; 93: 205-212https://doi.org/10.1007/s11060-008-9758-3
- Leptomeningeal metastasis: survival and prognostic factors in 155 patients.J. Neurol. Sci. 2004; 223: 167-178
- Prognostic factors and treatment options in patients with leptomeningeal metastases of different primary tumors: a retrospective analysis.J. Cancer Res. Clin. Oncol. 2010; 136: 1729-1735https://doi.org/10.1007/s00432-010-0831-x
- Predictors of preoperative and early postoperative seizures in patients with intra-axial primary and metastatic brain tumors: a retrospective observational single center study.Ann. Neurol. 2015; 78: 917-928https://doi.org/10.1002/ana.24522
- The problem of early diagnosis of brain tumours causing seizures only.J. Neurol. 1975; 210: 199-217
- Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases.J. Clin. Oncol. 2012; 30: 419
- Sex-specific trends in lung cancer incidence and survival: a population study of 40 118 cases.Thorax. 2011; 66: 301-307
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.
