Levetiracetam Prophylaxis Therapy for Brain Tumor-Related Epilepsy (BTRE) Is Associated With a Higher Psychiatric Burden

Fedele Dono; Stefano Consoli; Giacomo Evangelista; Annalisa Ricci; Mirella Russo; Claudia Carrarini; Angelo Di Iorio; Laura Bonanni; Francesca Anzellotti; Marco Onofrj; Stefano L Sensi

doi:10.3389/fneur.2021.806839

Levetiracetam Prophylaxis Therapy for Brain Tumor-Related Epilepsy (BTRE) Is Associated With a Higher Psychiatric Burden

Front Neurol. 2022 Jan 11:12:806839. doi: 10.3389/fneur.2021.806839. eCollection 2021.

Authors

Fedele Dono^{1

2}, Stefano Consoli¹, Giacomo Evangelista¹, Annalisa Ricci¹, Mirella Russo^{1

2}, Claudia Carrarini¹, Angelo Di Iorio³, Laura Bonanni³, Francesca Anzellotti⁴, Marco Onofrj^{1

2}, Stefano L Sensi^{1

2

5}

Affiliations

¹ Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
² Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
³ Department of Medicine and Ageing Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
⁴ Department of Neurology, "SS Annunziata" Hospital, Chieti, Italy.
⁵ Institute for Mind Impairments and Neurological Disorders (iMIND), University of California, Irvine, Irvine, CA, United States.

Abstract

Purpose: Brain tumor-related epilepsy (BTRE) is a condition characterized by the development of seizures in the context of an undergoing oncological background. Levetiracetam (LEV) is a third-generation anti-seizure medication (ASM) widely used in BTRE prophylaxis. The study evaluated LEV neuropsychiatric side effects (SEs) in BTRE prophylaxis. Method: Twenty-eight patients with brain tumors were retrospectively selected and divided into two groups. In one group, we evaluated patients with a BTRE diagnosis using LEV (BTRE-group). The other group included patients with brain tumors who never had epilepsy and used a prophylactic ASM regimen with LEV (PROPHYLAXIS-group). Neuropsychiatric SEs of LEV were monitored using the Neuropsychiatric Inventory Questionnaire (NPI-Q) at the baseline visit and the 6- and 12-month follow-up. Results: Eighteen patients of the BTRE-group and 10 patients of the PROPHYLAXIS-group were included. Compared to the BTRE-group, the PROPHYLAXIS-group showed a higher severity of neuropsychiatric symptoms. According to Linear Mixed Models (LMM), a multiplicative effect was observed for the interaction between group treatment and time. For the caregiver distress score (CDS), only a time-effect was observed. Conclusion: Prophylactic ASM with LEV is associated with an increased frequency of neuropsychiatric SE. Accurate epileptological evaluations in patients with brain tumors are mandatory to select who would benefit most from ASM.

Keywords: AMPA; brain tumor epilepsy; glutamate; psychiatry; side effect.