Long-term Effects of Antiseizure Therapy on Mood and Cognition in Meningioma Patients

Overview

This retrospective cohort analysis evaluated the impact of antiseizure medication (ASM) use, particularly levetiracetam, on depression, anxiety, and neurocognitive function in meningioma patients. The study found associations between ASM use and neuropsychiatric symptoms, with levetiracetam showing distinct effects compared to other ASMs.

Background

Meningiomas are the most common primary intracranial tumors in adults, often presenting with seizures and neuropsychiatric symptoms. Over one third of meningioma patients experience seizures, and ASM is recommended after a single seizure. While levetiracetam is commonly used due to its favorable drug interaction profile, evidence on its long-term effects on mood and cognition in meningioma patients remains limited. This study addresses the gap by analyzing neurocognitive and psychiatric outcomes in a large cohort of meningioma patients treated with ASM.

Data Highlights

Key Findings

• More than one third of meningioma patients experience seizures during their disease course.
• ASM use was independently associated with self-reported depression, anxiety, and cognitive impairment in meningioma patients.
• Levetiracetam, the most commonly prescribed ASM, was linked to anxiety and depression but may improve cognition compared to enzyme-inducing ASMs.
• Enzyme-inducing ASMs like phenytoin were associated with cognitive dysfunction in this population.
• Previous glioma-focused studies are poorly generalizable to meningioma patients due to differences in treatment regimens.
• This study utilized comprehensive neuropsychological testing and validated questionnaires to assess long-term neuropsychiatric outcomes.

Clinical Implications

Clinicians should carefully consider the choice of ASM in meningioma patients, balancing seizure control with potential neuropsychiatric side effects. Levetiracetam may be preferred due to its lower risk of drug interactions and possible cognitive benefits, but monitoring for mood symptoms is warranted. Tailored neurocognitive assessments can guide management and improve quality of life in this population.

Conclusion

ASM use in meningioma patients is associated with neuropsychiatric symptoms and cognitive impairment, with levetiracetam showing a distinct profile compared to other ASMs. These findings support individualized ASM selection and highlight the need for ongoing neuropsychiatric monitoring.

References

1. Various Authors/2023 -- Epidemiology and Clinical Features of Meningioma
2. Leiden University Medical Center et al./2016-2019 -- Neurocognitive and Psychiatric Assessment in Meningioma Patients