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To the Editor:
Jaeckle et al.1 retrospectively analyzed patients with newly diagnosed glioblastoma who had been treated in different trials. This finding conflicts with previous studies2,3 where overall survival (OS) was longer in 432 patients treated with enzyme-inducing anticonvulsants (EIAC) compared to 173 without this treatment.
We believe that seizures are frequently a presenting symptom occurring earlier in the course of a glioblastoma compared to other presenting symptoms and may be related to slower tumor progression.4 Therefore, patients with seizures are more likely to have longer OS. Jaeckle et al. suggest that in their population, immediate progression rates (IPRs) did not differ between these groups (37.9% vs 23.8%, p = 0.32). This highly relevant difference failed to be significant only because the seizure history was not known in 460 of 605 patients.
About 50% of patients with glioblastoma develop seizures, 36% of them at diagnosis.5 Even when assuming that the relatively low reported seizure rate of 14.5% (21/145) at baseline would apply to the whole study population, these IPRs would be significantly different (p = 0.011, χ2 test). Furthermore, OS was actually 16.4 months in seizure patients on EIAC vs 12.4 in nonseizure patients on EIAC (difference 32%) compared to 12.3 in all patients on EIAC vs 10.7 for all non-EIAC patients (difference 14%). This suggests a greater impact of having seizures on survival than of taking EIAC.
No data regarding tumor volume and localization at inclusion or …
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