TY - JOUR T1 -编者注:抗癫痫药物双重治疗在胶质瘤患者中的有效性:一项多中心观察队列研究JF -神经学JO -神经学SP - 105 LP - 105 DO - 10.1212/WNL.0000000000201717半岛投注体育官网六世- 100 - 2非盟- Aravind Ganesh盟史蒂文Galetta Y1 - 2023/01/10 UR - //www.ebmtp.com/c半岛投注体育官网ontent/100/2/105.1.abstract N2 -多中心回顾性队列研究的1435例胶质瘤后36个月,范德梅尔博士等人检查是否levetiracetam结合丙戊酸(LEV + VPA),常用duotherapy控制癫痫发作,比其他更有效duotherapy组合,包括列弗或VPA。在355例接受放射治疗的患者中，66%的患者接受了LEV + VPA，而接受其他放射治疗的患者由于不受控制的癫痫发作而导致治疗失败的风险更高，但不是由于不良反应。作者得出结论，LEV + VPA在他们的患者群体中比其他抗癫痫药物组合有更好的疗效。作为回应，赵博士等人建议根据更新后的2021年世界卫生组织指南重新分类患者的胶质瘤等级，而不是他们使用的2016年指南，考虑到治疗和癫痫风险的潜在不同影响。他们还认为，LEV + VPA组与对照组在皮质类固醇的使用和手术切除方面的差异可能影响了癫痫的严重程度。针对这些评论，作者指出，他们的患者是在2004年至2018年期间接受治疗的，当时2016年世卫组织标准正在使用，他们认为重新分类患者不会改变他们的结果，指出缺乏证据表明抗癫痫药物在低级别胶质瘤和高级别胶质瘤中具有不同的疗效。他们承认缺乏他们的研究对象使用皮质类固醇的数据，但指出即使有这些数据，将这些数据纳入分析也很复杂。他们指出，在Cox比例风险模型中，他们确实将手术切除作为一个潜在的混杂因素进行了调整，但承认需要在随机对照试验中验证他们的发现。这种交流证明了在脑肿瘤(如胶质瘤)患者癫痫治疗的观察性研究中可能出现的重要混杂因素。In a multicenter retrospective cohort study of 1,435 patients with glioma followed up to 36 months, Dr. van der Meer et al. examined whether levetiracetam combined with valproic acid (LEV + VPA), a commonly prescribed duotherapy for uncontrolled seizures, is more effective than other duotherapy combinations that included either LEV or VPA. Of 355 patients receiving duotherapy, 66% received LEV + VPA, and patients receiving other duotherapy had a higher risk of treatment failure due to uncontrolled seizures but not due to adverse effects. The authors concluded that LEV + VPA had better efficacy than other antiseizure medication combinations in their patient population. In response, Dr. Zhao et al. suggest reclassifying the patients' glioma grades according to the updated 2021 World Health Organization guidelines instead of the 2016 guidelines that they had used, given the potentially different implications for treatment and epilepsy risk. They also argue that differences in the use of corticosteroids and surgical resection between the LEV + VPA group and the comparison group may have influenced the severity of epilepsy. Responding to these comments, the authors note that their patients were treated between 2004 and 2018 when the 2016 WHO criteria were in use, and they contend that reclassifying the patients would not change their results, pointing to the absence of evidence that antiseizure medications would have different efficacies in low-grade vs high-grade glioma. They acknowledge the lack of data on corticosteroid use for their cohort, but point to complexities in incorporating such data into analyses even if they were available. They note that they did adjust for surgical resection as a potential confounder in their Cox proportional hazards model but acknowledge the need for validation of their findings in a randomized controlled trial. This exchange demonstrates important confounders that can arise in observational studies of epilepsy treatment in patients with brain tumors such as gliomas. ER -