Anticonvulsant Prophylaxis and Steroid Use in Adults With Metastatic Brain Tumors
Based on guidelines from the Congress of Neurological Surgeons, also endorsed by ASCO and SNO.
Anticonvulsants
Antiepileptic Drugs
Prophylactic antiepileptic drugs are not recommended for routine use in patients with brain metastases who did not undergo surgical resection and who are otherwise seizure free.
Level 3
Routine postcraniotomy antiepileptic drug use for seizure-free patients with brain metastases is not recommended.
Level 3
Steroid Therapy vs No Steroid Therapy
Steroid Therapy vs No Steroid Therapy
For asymptomatic brain metastases patients without mass effect, insufficient evidence exists to make a treatment recommendation for this clinical scenario.
N/A
For brain metastases patients with mild symptoms related to mass effect, corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brain metastases. It is recommended for patients who are symptomatic from metastatic disease to the brain that a starting dose of dexamethasone 4 to 8 mg/day be considered.
Level 3
For brain metastases patients with moderate to severe symptoms related to mass effect, corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brain metastases. If patients exhibit severe symptoms that are consistent with increased intracranial pressure, it is recommended that higher doses, such as 16 mg/day or more, be considered.
Level 3
Choice of Steroid
If corticosteroids are administered, dexamethasone is the best drug choice given the available evidence.
Level 3
Duration of Corticosteroid Administration
Corticosteroids, if administered, should be tapered as rapidly as possible, but no faster than clinically tolerated, on the basis of an individualized treatment regimen and a full understanding of the long-term sequelae of corticosteroid therapy.
Level 3
Dosing
The Panel’s expert opinion is that, given the important adverse effects of steroids, the minimum effective dose (often no more than 4 mg) should be used where possible and night-time doses of steroids should be avoided to minimize toxicity.
N/A
What do the icons mean?
How much evidence supports it?
Level 1
Evidence was obtained from one or more-well designed, randomized controlled clinical trial, including overviews of such trials.
Level 2
Evidence was obtained from one or more well-designed comparative clinical studies, such as non-randomized cohort studies, case-control studies, and other comparable studies, including less well-designed randomized controlled trials.
Level 3
Evidence was obtained from case series, comparative studies with historical controls, case reports, and expert opinion, as well as significantly flawed randomized controlled trials.N/A
No evidence was assigned.
