Antiepileptic Medication Considerations

First-Line Treatment Options

The American Society of Clinical Oncology recommends levetiracetam and lamotrigine as preferred first-line options due to their efficacy and favorable tolerability profiles 1
Lamotrigine has good antiseizure activity but requires several weeks to reach sufficient drug levels 1
Lacosamide may assume a larger role as add-on treatment for patients whose seizure disorder is not controlled by monotherapy 1
Valproate still has a firm place in some centers given its efficacy and overall good tolerability, but must not be used in females who may become pregnant 1

Enzyme-inducing anticonvulsants, such as phenytoin, phenobarbital, and carbamazepine, should be avoided in patients with brain tumors and those requiring multiple medications due to their side-effect profile and drug interactions 1

Levetiracetam is considered safer in patients with brain tumors requiring concomitant medications due to its low interaction with cytochromes 2
Antiepileptic therapy appears safe during immunotherapy but can interact with targeted therapy, with the exception of levetiracetam 2