The role of prophylactic anticonvulsants in the management of brain metastases: a systematic review and evidence-based clinical practice guideline

Tom Mikkelsen, Nina A Paleologos, Paula D Robinson, Mario Ammirati, David W Andrews, Anthony L Asher, Stuart H Burri, Charles S Cobbs, Laurie E Gaspar, Douglas Kondziolka, Mark E Linskey, Jay S Loeffler, Michael McDermott, Minesh P Mehta, Jeffrey J Olson, Roy A Patchell, Timothy C Ryken, Steven N Kalkanis
Journal of Neuro-oncology 2010, 96 (1): 97-102

QUESTION: Do prophylactic anticonvulsants decrease the risk of seizure in patients with metastatic brain tumors compared with no treatment?

TARGET POPULATION: These recommendations apply to adults with solid brain metastases who have not experienced a seizure due to their metastatic brain disease.

RECOMMENDATION: Level 3 For adults with brain metastases who have not experienced a seizure due to their metastatic brain disease, routine prophylactic use of anticonvulsants is not recommended. Only a single underpowered randomized controlled trial (RCT), which did not detect a difference in seizure occurrence, provides evidence for decision-making purposes.

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