anti seizure meds in PCNSL

 Q: 48 years old male is admitted to ICU with mental status change. Subsequent workup led to the diagnosis of Central Nervous System Lymphoma (PCNSL). Oncology service has been consulted. Anticonvulsants should be used in this patient as prophylaxis? (select one) 

A) Yes 

B) No 

Answer: B

Although patients with PCNSL are at increased risk for seizures, prophylactic anti-seizure meds are not indicated. This is due to the finding that their prescription has no effect on the frequency of subsequent seizures. Also, anticonvulsants can harm the patient due to their high tendency of drug-drug interaction with chemotherapy and dexamethasone, the most used steroids. 

In general, except for metastatic melanoma anti-seizure drugs are not used in primary or metastatic brain tumors without any evidence of seizure. Anticonvulsants should be added only when there are documented or witnessed seizures.

#oncology

#neurology

References:

1. Sirven JI, Wingerchuk DM, Drazkowski JF, et al. Seizure prophylaxis in patients with brain tumors: a meta-analysis. Mayo Clin Proc 2004; 79:1489. 

2. Tremont-Lukats IW, Ratilal BO, Armstrong T, Gilbert MR. Antiepileptic drugs for preventing seizures in people with brain tumors. Cochrane Database Syst Rev 2008; :CD004424. 

3. Mikkelsen T, Paleologos NA, Robinson PD, et al. The role of prophylactic anticonvulsants in the management of brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 2010; 96:97. 

4. Goldlust SA, Hsu M, Lassman AB, et al. Seizure prophylaxis and melanoma brain metastases. J Neurooncol 2012; 108:109.