Prophylactic anticonvulsants in patients with primary glioblastoma

Glioblastoma is the most common form of primary brain cancer in adults and one of the deadliest of human cancers. Seizures are one of the most frequent presentations of glioblastoma. The use of anti-epileptic drugs (AEDs) in glioblastoma patients suffering from seizures is well accepted. However, the role of long-term AED use in patients with glioblastoma without a history of seizures is controversial. Here, we performed a review of the literature to identify studies that examined the use of AEDs in seizure-free glioblastoma patients. We identified one randomized controlled study suggesting no clinical benefit of seizure prophylaxis in this population. Three of the four retrospective studies identified in our search recapitulated this finding, while the remaining study suggested a benefit for prophylactic AED use. All identified studies were focused on seizure incidence in the post-operative period, ranging from 1 week to long-term follow up. Implications of these findings are reviewed herein.