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Aim  The aim of this present study was to determine the frequency, as well as risk factors, for seizures and antiepileptic drug ( AED )‐associated adverse effects among high‐grade glioma (HGG) patients.    Patients and Methods  A multicentre, retrospective study of adult  C hinese  H ong  K ong patients from three neurosurgical centres diagnosed with supratentorial HGG between 1  J anuary 2001 and 31  D ecember 2010 was performed.    Results  A total of 198 patients, with a mean age of 55 years (range: 18–88) and a mean follow up of 15 months, was recruited. Most suffered from glioblastoma multiforme ( GBM ) (63 per cent) followed by anaplastic astrocytoma (25 per cent). Median overall survival for patients with  GBM  was 8 months, and 11 months for those with grade  III  gliomas. Prophylactic  AED  was prescribed in 165 patients (83 per cent), and 64 per cent of patients were continued until end of life or last follow up. A total of 112 patients (57 per cent) experienced seizures at a mean duration of 8 months postoperatively (range: 1 day–75 months). Independent predictors for seizures were a diagnosis of  GBM  [adjusted odds ratio ( OR ): 2.33, 95 per cent confidence interval ( CI ): 1.21–4.52] and adjuvant radiotherapy (adjusted  OR : 2.97, 95 per cent CI: 1.49–6.62).  One ‐fifth of patients (21 per cent) experienced  AED  adverse effects, with idiosyncratic cutaneous reactions and hepatotoxicity most frequently observed. An independent predictor for adverse effects was exposure to aromatic  AED , such as phenytoin, carbamazepine and phenobarbital (adjusted  OR : 3.32, 95 per cent  CI : 1.32–8.40).    Conclusions  Antiepileptic drug prescription for primary seizure prophylaxis is both pervasive and prolonged for  HGG  patients. Seizures occur frequently, but most were delayed and none were life threatening. Judicious prescription of  AED  is required, especially when a significant proportion of patients experience adverse effects. Patients with a diagnosis of  GBM  and exposure to radiotherapy are at risk. We suggest, contrary to present practice, that primary seizure prophylaxis be given only during the perioperative period and resumed when they occur. We also recommend avoidance of aromatic  AED  due to their association with idiosyncratic adverse effects.

surgical practice

Risk factors for seizures and antiepileptic drug‐associated adverse effects in high‐grade glioma patients: A multicentre, retrospective study in  H ong  K ong