
==== Front
Brain Spine
Brain Spine
Brain & Spine
2772-5294
Elsevier

S2772-5294(24)00173-5
10.1016/j.bas.2024.102917
102917
Brain
Letter to the editor concerning “effects of Levetiracetam and Lacosamide on survival and seizure control in 2IDH-wild type glioblastoma during temozolomide plus radiation adjuvant therapy” by Andrea Bianconi et al
Kandaswamy Karthikeyan
Department of Cariology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, 600077, Tamil Nadu, India
Guru Ajay ajayguru.sdc@saveetha.com
⁎
Department of Cariology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, 600077, Tamil Nadu, India
⁎ Corresponding author. ajayguru.sdc@saveetha.com
06 8 2024
2024
06 8 2024
4 10291728 7 2024
5 8 2024
© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Handling Editor: W Peul
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pmcDear Editor,

The study by Andrea Bianconi et al. (2024) title "Effects of Levetiracetam and Lacosamide on survival and seizure control in IDH-wild type glioblastoma during temozolomide plus radiation adjuvant therapy" addresses a critical and timely aspect of glioblastoma (GBM) management, particularly the efficacy of antiseizure medications (ASMs) levetiracetam (LEV) and lacosamide (LAC) in controlling brain tumor-related epilepsy (BTRE). Effective management of BTRE is paramount in improving the quality of life and overall prognosis for GBM patients. Recently AI is rewiring our approach to neuro related problems (Sudhakaran, 2024). This study provides valuable insights into the comparative effectiveness and tolerability of these ASMs, potentially informing clinical practice and enhancing patient care strategies.

While the study presents valuable information, there are several methodological and interpretative issues that might affect the robustness and generalizability of the findings. A significant concern is the potential selection bias, particularly in the administration of LAC, which was less frequently used as a first-line treatment compared to LEV. This discrepancy might introduce bias, as LAC was often employed as an add-on therapy in more severe cases or among patients with more epileptogenic tumors, potentially skewing the results in favor of LEV's efficacy. Additionally, while the study adjusts for some confounding variables such as preoperative seizure history and MGMT promoter methylation status, it lacks comprehensive details on other critical factors like dosage, duration, and combination of treatments, which could significantly influence both seizure recurrence and survival outcomes.

Another significant issue is the study's conclusion that MGMT promoter hypermethylation may have a protective effect against seizure recurrence, contradicting recent literature that suggests low MGMT expression levels correlate with a higher likelihood of postoperative seizures. This inconsistency calls into question the reliability of the molecular data presented. Additionally, the study's retrospective design and single-institution nature limit its generalizability, making it challenging to apply the findings broadly across different clinical settings. The lack of detailed follow-up protocols further compounds the problem, potentially leading to inconsistencies in data collection and the reporting of seizure and survival outcomes. It would be beneficial to conduct more rigorous prospective studies with standardized treatment and follow-up protocols to address these issues. Ensuring comprehensive data collection on treatment dosages, durations, and combinations will provide a clearer understanding of their impact on seizure control and survival. Additionally, addressing potential selection biases and aligning molecular data with current literature will enhance the reliability and applicability of the findings. These improvements would significantly strengthen the study's contributions to the field and offer more definitive guidance for the management of BTRE in GBM patients.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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Reference

Bianconi A. Koumantakis E. Gatto A. Zeppa P. Saaid A. Nico E. Bruno F. Pellerino A. Rizzo F. Junemann C.V. Effects of Levetiracetam and Lacosamide on survival and seizure control in IDH-wild type glioblastoma during temozolomide plus radiation adjuvant therapy Brain and Spine. 4 2024 102732
Sudhakaran G. Intelligence overload: how AI is rewiring our approach to neurodegenerative diseases Brain Spine 4 2024 Jul 11 102868
