|Home | About | Journals | Submit | Contact Us | Français|
It was with both amazement and regret that we read your article “The course of neurocognitive functioning in high-grade glioma patients” by Bosma et al. (Neuro-Oncology 2007;9:53–62).1
The authors state in the first page of the article that “patients with tumor progression performed worse on neurocognitive tests than did patients without progression, which could be attributed to the use of antiepileptic drugs,” without referencing which specific antiepileptic drugs the study addressed. In fact, in Table 2 of the article, titled “Characteristics at baseline of 68 glioma patients stratified by neurocognitive follow-up,” the authors included “Antiepileptic drug use (%)” as a characteristic but again did not specify which drugs their patients were using.
Our team has been researching the newer antiepileptic drugs (AEDs) over the past few years, specifically topiramate, levetiracetam, and oxcarbazepine,2,3 in order to explore both the positive and negative characteristics of these newer drugs with respect to the older AEDs. It is precisely due to the fact that there is a vast array of AEDs to choose from (both older and newer) when prescribing a patient’s drug treatment that attention must be given to the specific characteristics of each drug; they simply cannot and should not be lumped together in any discussion or research project. Not identifying the specific drugs that were encountered during a study seems to undermine all of the research that has been done to date concerning AEDs.
In fact, it is the previous research of Dr. Martin Klein, one of the article’s coauthors, that was directly responsible for encouraging our team to take a look at the single AEDs (the newer drugs) and the possible contribution they might make in improving patient therapy. An important article, “Epilepsy in low-grade gliomas: The impact on cognitive function and quality of life” (Annals of Neurology 2003;54:514–520),4 also coauthored by Dr. Klein, makes specific reference to the individual drugs carbamazepine, valproic acid, phenytoin, and phenobarbital (older AEDs); in this article, Klein et al. state in the discussion section that their findings “suggest that primarily AED therapy rather than seizure frequency negatively affects cognitive function in these patients—mostly using established AEDs. The newer AEDs, including gabapentin, lamotrigine, and oxcarbazepine, might control seizures as effectively as the established AEDs, and possibly have fewer and less severe side effects.” This statement contributed enormously to our team’s decision to study the newer AEDs.
We firmly believe that for patients with brain tumor–related epilepsy, the primary objective should be to improve their quality of life by reducing seizure frequency and improving cognitive performance. One of the best ways to achieve this important objective (i.e., improvement of quality of life) is to choose the specific AED that fits the individual patient profile. Bosma et al. mention that “the possibility of deleterious effects is important to consider when prescribing antiepileptic drug treatment.” However, if we are to consider the possible deleterious effect of a drug, the most essential element in this consideration is identification of the specific drug we are examining.
Certainly, Bosma et al. obtained the data pertaining to which specific AEDs the patients in the study were utilizing in their therapy, and for this reason we simply cannot understand why this data was not published. The article in its present state remains an important document, but it lacks the most important part of the puzzle. It could have been a much more valuable resource had the specific AEDs been mentioned. Omitting them leaves the impression of something incomplete and leaves researchers like us frustrated at not being able to move forward.
Thank you for the attention given to our observation.
Marta Maschio, Loredana Dinapoli, Alessia Zarabla, and Bruno Jandolo