Practice parameter: Anticonvulsant prophylaxis in patients with newly diagnosed brain tumors Report of the Quality Standards Subcommittee of the American Academy of Neurology

摘要: The Quality Standards Subcommittee seeks to develop scientifically sound, clinically relevant practice parameters for the of neurology. Practice are strategies patient management that assist physicians in clinical decision making. A parameter is one or more specific recommendations based on analysis evidence a problem. These might include diagnosis, symptoms, treatment, procedure evaluation. American Academy Neurology (AAN) members have requested publication use prophylactic anticonvulsants patients with primary and metastatic brain tumors. Physicians often administer anticonvulsant medication prophylactically tumors, despite lack definitive therapy effective preventing first seizures.1-4 If medications were free side effects, their be attractive even without such evidence. However, discomfort, expense, inconvenience result from drug treatment periodic monitoring serum concentrations. Typical anticonvulsant-induced including cognitive impairment, myelosuppression, liver dysfunction, dermatologic reactions (ranging minor rashes life-threatening Stevens–Johnson syndrome), appear occur frequently tumors than other groups,3,5-16 although direct comparison studies not been published. spectrum effects unique must also considered. Phenytoin, carbamazepine, phenobarbital reduce efficacy corticosteroids,17-21 which administered almost universally tumor patients. In addition, ability these stimulate cytochrome P450 enzyme system results markedly accelerated metabolism wide chemotherapeutic agents nitrosoureas, paclitaxel, cyclophosphamide, topotecan, irinotecan, thiotepa, 9-aminocampothecin, adriamycin, methotrexate.22-34 As result, inadequate dosing has identified recently as widespread critically important problem.35 Conversely, …