Antiepileptic drugs failed to prevent initial seizures or improve survival outcomes in patients with primary CNS lymphoma.

in Scientific reports by Mengxue Zhang, Yunan Ling, Yanwei Zeng, Jingjing Ma, Zhiguang Lin, Qing Li, Hui Kang, Bobin Chen, Yan Ma

TLDR

  • A retrospective study found that epilepsy affects 16.82% of patients with primary central nervous system lymphoma, and that antiepileptic drugs do not reduce seizure incidence or improve progression-free survival.
  • The study suggests that antiepileptic drugs should not be used as preventive measures in PCNSL patients.
  • Future research is needed to identify reliable risk factors for epilepsy in PCNSL patients and to develop effective treatment strategies.

Abstract

This study examined the prevalence, risk factors, and prognosis of epilepsy in patients with primary central nervous system lymphoma (PCNSL) and explored the necessity of prophylactic antiepileptic treatment in this population. In this retrospective, observational, single-center study, we analyzed clinical data from PCNSL patients who were diagnosed at our institution between January 2018 and April 2023. The cohort comprised 214 patients with PCNSL (with a median age of 62 years), of which 128 (47.6%) patients were male. Epilepsy was observed in 16.82% (36/214) of the patients, with 9.35% (20/214) presenting with seizures as the initial symptom. Cortical involvement was significantly associated with seizures (OR = 9.512, 95% CI 3.870-23.381; p = 0.036). Other potential risk factors included an edema zone > 1 cm around the lesion and PIM1 wild-type status. Antiepileptic drugs (AEDs) neither reduced seizure incidence (8.11% with AEDs vs. 8.43% with no AEDs, p = 0.970) nor improved PFS (HR = 0.613, 95% CI 0.338-1.109; p = 0.106). Therefore, AEDs should not be used as preventive measures in this population.

Overview

  • This study assessed the prevalence, risk factors, and prognosis of epilepsy in patients with primary central nervous system lymphoma (PCNSL).
  • The study analyzed clinical data from 214 PCNSL patients who were diagnosed between January 2018 and April 2023.
  • The primary objective was to explore the necessity of prophylactic antiepileptic treatment in PCNSL patients.

Comparative Analysis & Findings

  • Epilepsy was observed in 16.82% (36/214) of the patients, with 9.35% (20/214) presenting with seizures as the initial symptom.
  • Cortical involvement was significantly associated with seizures, as well as an edema zone > 1 cm around the lesion and PIM1 wild-type status.
  • Antiepileptic drugs (AEDs) neither reduced seizure incidence nor improved progression-free survival (PFS).

Implications and Future Directions

  • The study suggests that antiepileptic drugs should not be used as preventive measures in PCNSL patients.
  • Further research is needed to identify reliable risk factors for epilepsy in PCNSL patients and to develop effective treatment strategies.
  • Future studies should aim to validate the current findings and investigate the potential role of other therapeutic agents in preventing or managing epilepsy in PCNSL patients.
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