Nonstandard Prescription Practices of Antiseizure Medications for Patients with Supratentorial Tumors Presenting without Seizures

Primary central nervous system tumors occur in children presenting with complaints such as headache, ataxia, weakness, and numbness. Patients with supratentorial tumors often have comorbid seizures at presentation, but a minority do not. For patients presenting with supratentorial tumors without seizures, the practice of initiating and stopping seizure medications is nonstandard. We wrote a survey which was administered to neurosurgeons in the Pediatric Neuro-Oncology Consortium (PNOC) which demonstrated nonstandard initiation of antiseizure medications such as levetiracetam in this population with variable criteria for initiation including prophylactically regardless of patient history (11/22,50%), with an abnormal electroencephalography (EEG) regardless of history (1/22,4.5%), and following seizure regardless of other features (10/22,45.5%) which is not statistically significant (p = 0.66, χ2 = 0.18). The location of the tumor also appears to have some impact on the prescription of antiseizure medications as there was a trend for significance for tumors located in specific lobes (15/22,68.2%) while a minority of providers would not prescribe antiseizure medication (7/22,31.8%) regardless of tumor lobe location (p = 0.08, χ2 = 2.9). We also found nonstandard weaning practice from providers with responses being 7 days post-op (10/22,45.5%), weeks to months with seizure precautions only (3/22,13.6%), weeks to months with negative follow up EEG (2/22,9.1%), weeks to months with negative follow up EEG and Magnetic Resonance Imaging (MRI) of the brain showing no recurrence of disease (1/22,4.5%), 1 year seizure freedom with negative follow up EEG and MRI of the brain showing no recurrence of disease (1/22,4.5%), and other (5/22,22.8%). Even with the most common weaning practice which is weaning at post-op day 7 (10/22,45.5%) versus all other weaning practices (12/22,54.5%), we again demonstrate equipoise as this difference is not statistically significant (p = 0.66, χ2 = 0.18). We demonstrate a nonstandard medical practice due to heightened but uncertain risk of occurrence of seizures in children who have supratentorial tumors but who have never had seizures previously. These results implicate the need for prospective registries or clinical trials to demonstrate clinical effectiveness of antiseizure medications in this tumor subpopulation.