Partial Brain and Dilantin

[Mandelin Rain]

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I've typically requested that patients come off Dilantin prior to any cranial radiation due to risk EMPACT (eythema multiforme).

Hypothetical Glioma patient on Keppra and Dilantin and the Neuro Onc refuses to remove the Dilantin during radiation. What is your course of action? Do you treat regardless or refuse to treat?

 

[Gfunk6]

I've never heard of this phenomenon. What's the incidence? I guess have to weigh the risk of bad dermatitis vs breakthrough seizures.

 

[Mandelin Rain]

Here is a recent review
PMID: 24792490
Journal of Neuro-Oncology
August 2014, Volume 119, Issue 1, pp 129-134

Mostly case reports. It is a rare phenomenon to be sure, but can be severe and spread to whole body.

 

[RadRadRad]

Saw something similar to this once in residency. patient was receiving whole brain radiation for mets. Almost all of my patients these days receive Keppra without dilantin. Would not withhold treatment as incidence of this is low. Consent patient to cover yourself.