***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: OBJECTIVE To evaluate the efficacy and safety of levetiracetam in the management of epilepsy in patients with glioma . DESIGN A prospect i ve study in hospitalized patients with a new diagnosis of glioma . SETTING Department of Neurological Sciences and Visions , Spedali Civili of Brescia . PATIENTS From March 1 , 2006 , until January 1 , 2009 , 176 consecutive patients ( 101 men and 75 women ) with a first diagnosis of glioma were enrolled in the study . All patients with a diagnosis of epilepsy were treated with levetiracetam . MAIN OUTCOME MEASURES Clinical , histological , and magnetic resonance imaging findings were analyzed . RESULTS Age at the diagnosis of glioma ranged from 22 to 79 years ( mean [ SD ] , 57 [ 15 ] years ; median , 59 years ) . Duration of the disease ranged from 27 days to 2(1/2 ) years ( mean [ SD ] , 13.7 [ 7.8 ] months ; median , 13 months ) . Eighty-two patients received levetiracetam because of a diagnosis of epilepsy . At the last evaluation ( May 1 , 2009 ) , 75 of 82 patients ( 91 % ) treated with levetiracetam were seizure free ; in 2 of these patients , levetiracetam was withdrawn because of intolerable adverse effects . Prompt and long-lasting control of seizures was obtained in 49 of 82 patients ( 60 % ) with a dose of levetiracetam that ranged from 1500 to 3000 mg/d , and 9 ( 11 % ) of the treated patients needed an increase of levetiracetam dosage to 4000 mg/d to become seizure free . No laboratory abnormalities were observed in patients with concomitant chemotherapy . CONCLUSION The results of this study provide good evidence that levetiracetam is efficacious and safe in patients with epilepsy due to glioma Background Seizure control does n't represent the only challenging goal in patients with brain tumor-related epilepsy . Side effects have often taken precedence for patients ' quality of life . Methods We performed an observational retrospective study on patients with brain tumor-related epilepsy : 35 who had assumed oxcarbazepine monotherapy and 35 patients who had undergone treatment with traditional antiepileptic drugs .  Primary variable of efficacy was the mean seizure frequency per month and safety variables were the drop-out for side effects and total incidence of side effects . We applied the Propensity Score technique to minimize selection bias . Results Our results showed a similar efficacy of oxcarbazepine and traditional antiepileptic drugs over time , but the difference in safety and tolerability between the two groups was significant : traditional AEDs caused more side effects , both serious and non serious . Conclusion This study highlights the importance of taking into consideration not only seizure control but also the appearance of side effects when choosing antiepileptic drugs in this patients population A retrospective study of 1000 patients who had undergone supratentorial neurosurgery and with prolonged follow-up revealed an overall postoperative incidence of epilepsy of 17 % . The incidence varied with different pathologies but anticonvulsants given prophylactically in a r and omized trial did not significantly alter the incidence . Routine anticonvulsant prophylaxis can not be recommended Seizures are common in patients with gliomas , and phenytoin ( PHT ) is frequently used to control tumor-related seizures . PHT , however , has many undesirable side effects ( SEs ) and drug interactions with glioma chemotherapy . Levetiracetam ( LEV ) is a newer antiepileptic drug ( AED ) with fewer SEs and essentially no drug interactions . We performed a pilot study testing the safety and feasibility of switching patients from PHT to LEV monotherapy for postoperative control of glioma-related seizures . Over a 13-month period , 29 patients were r and omized in a 2:1 ratio to initiate LEV therapy within 24 h of surgery or to continue PHT therapy . 6 month follow-up data were available for 15 patients taking LEV and for 8 patients taking PHT . In the LEV group , 13 patients ( 87 % ) were seizure-free . In the PHT group , 6 patients ( 75 % ) were seizure-free . Reported SEs at 6 months was as follows ( % LEV/%PHT group ) : dizziness ( 0/14 ) , difficulty with coordination ( 0/29 ) , depression ( 7/14 ) lack of energy or strength ( 20/43 ) , insomnia ( 40/43 ) , mood instability ( 7/0 ) . The pilot data presented here suggest that it is safe to switch patients from PHT to LEV monotherapy following craniotomy for supratentorial glioma . A large-scale , double-blinded , r and omized control trial of LEV versus PHT is required to determine seizure control equivalence and better assess differences in SEs BACKGROUND In patients with brain tumors , the choice of antiepileptic medication is guided by tolerability and pharmacokinetic interactions . This study investigated the effectiveness of levetiracetam ( LEV ) and pregabalin ( PGB ) , 2 non-enzyme-inducing agents , in this setting . METHODS In this pragmatic , r and omized , unblinded phase II trial ( NCT00629889 ) , patients with primary brain tumors and epilepsy were titrated to a monotherapy of LEV or PGB .  Efficacy and tolerability were assessed using structured question naires . The primary composite endpoint was the need to discontinue the study drug , add-on of a further antiepileptic treatment , or occurrence of at least 2 seizures with impaired consciousness during 1 year follow-up . RESULTS Over 40 months , 25 patients were r and omized to LEV , and 27 to PGB . Most were middle-aged men , with a high- grade tumor and at least one generalized convulsion . Mean daily doses were 1125 mg ( LEV ) and 294 mg ( PGB ) . Retention rates were 59 % in the LEV group , and 41 % in the PGB group . The composite endpoint was reached in 9 LEV and 12 PGB patients -need to discontinue : side effects , 6 LEV , 3 PGB ; lack of efficacy , 1 and 2 ; impaired oral administration , 0 and 2 ; add-on of another agent : 1 LEV , 4 PGB ; and seizures impairing consciousness : 1 in each . Seven LEV and 5 PGB subjects died of tumor progression . CONCLUSIONS This study shows that LEV and PGB represent valuable monotherapy options in this setting , with very good antiepileptic efficacy and an acceptable tolerability profile , and provides important data for the design of a phase III trial Summary Background Levetiracetam ( LEV ) is a newer anticonvulsant with a favorable safety profile . There seem to be no relevant drug interactions , and an intravenous formulation is available . Therefore , LEV might be a suitable drug for the perioperative anticonvulsive therapy of patients with suspected brain tumors undergoing neurosurgery . Methods In this prospect i ve study ( NCT00571155 ) patients with suspected primary brain tumors and tumor-related seizures were perioperatively treated with oral and intravenous LEV up to 4 weeks before and until 4 weeks after a planned neurosurgical procedure . Findings Thirty patients with brain tumor-related seizures and intended neurosurgery were included . Three patients did not undergo the scheduled surgery after enrollment , and two patients were lost to follow-up . Therefore , 25 patients were fully evaluable . After initiation of therapy with LEV , 100 % of the patients were seizure-free in the pre-surgery phase ( 3 days up to 4 weeks before surgery ) , 88 % in the 48 h post-surgery phase and 84 % in the early follow-up phase ( 48 h to 4 weeks post surgery ) . Treatment failure even after dose escalation to 3,000 mg/day occurred in three patients . No serious adverse events related to the treatment with LEV occurred . Conclusion Our data show the feasibility and safety of oral and intravenous LEV in the perioperative treatment of tumor-related seizures . Although this was a single arm study , the efficacy of LEV appears promising . Considering the side effects and interactions of other anticonvulsants , LEV seems to be a favorable option in the perioperative treatment of brain tumor-related seizures Background : The risk of developing immediate postoperative seizures in patients undergoing supratentorial brain tumor surgery without anti-epileptic drug ( AED ) prophylaxis is 15 - 20 % . Patients who present with pre-operative seizures and patients with supratentorial meningioma or supratentorial low grade gliomas are at significantly higher risk . There is little data on the efficacy of levetiracetam as a prophylactic AED in the immediate postoperative period ( within 7 days of surgery ) in these patients . Methods : We conducted a retrospective chart review of 165 adult patients classified as higher risk for postoperative seizures who underwent brain tumor resection at Duke University Hospital between time May 2010 and December 2011 . All patients had received levetiracetam monotherapy in doses of 1000 - 3000 mg/day in the immediate postoperative period . Results : We identified 165 patients with following tumor locations : Frontal 83 ( 50.3 % ) , Temporal 37 ( 22.4 % ) , Parietal 30 ( 18.2 % ) , Occipital 2 ( 1.2 % ) and 13 ( 7.8 % ) with single lesions involving more than one lobe . Histology revealed : Glioma 98 ( 59.4 % ) , Meningioma 57 ( 34.5 % ) and Brain Metastases 6 ( 3.6 % ) . Preoperatively , 88/165 ( 53.3 % ) patients had presented with seizures . 12/165 patients ( 7.3 % ) developed clinical seizures ( generalized 10 , partial 2 ) in the immediate post-operative period . Other than somnolence in 7 patients ( 4.2 % ) , no major side-effects were noted . Conclusions : The incidence of seizures was significantly lower in patients treated with levetiracetam ( 7.3 % ) when compared with the expected ( 15 - 20 % ) rate without AED prophylaxis based on the previous literature . Levetiracetam appears effective and safe for seizure prevention in patients undergoing brain tumor resection and who are at significantly higher risk of developing post-operative seizures . These findings warrant confirmation in a prospect i ve r and omized trial Objective Phenytoin ( PHT ) is routinely used for seizure prophylaxis in patients with brain tumours during and after craniotomy , despite incomplete evidence . We performed a prospect i ve , r and omised study to investigate the significance of prophylactic use of levetiracetam ( LEV ) , in comparison with PHT , for patients with supratentorial tumours in the perioperative period . Methods Patients were r and omised to receive LEV , 500 mg/body every 12 h until postoperative day 7 , or PHT , 15–18 mg/kg fosphenytoin followed by 125 mg PHT every 12 h until postoperative day 7 . The primary end point was the occurrence of seizures , and secondary end points included the occurrence of haematological and non-haematological adverse events . Results One hundred and forty-six patients were r and omised to receive LEV ( n=73 ) or PHT ( n=73 ) . The incidence of seizures was significantly less in the LEV group ( 1.4 % ) compared with the PHT group ( 15.1 % , p=0.005 ) , suggesting benefit of LEV over PHT . The observed OR for being seizure free in the LEV prophylaxis group relative to the PHT group was 12.77 ( 95 % CI 2.39 to 236.71 , p=0.001 ) . In a subgroup analysis of patients who did not have seizures before craniotomy , similar results were demonstrated : the incidence of seizures was 1.9 % ( LEV ) and 13.8 % ( PHT , p=0.034 ) , and OR was 8.16 ( 95 % CI 1.42 to 154.19 , p=0.015 ) . LEV was completed in all cases , although PHT was withdrawn in five patients owing to liver dysfunction ( 1 ) , skin eruption ( 2 ) and atrial fibrillation ( 2 ) . Conclusions Prophylactic use of LEV in the perioperative period is recommended because it is safe and significantly reduces the incidence of seizures in this period . Trial registration number UMIN13971 Epilepsy in patients with brain tumours is common . The incidence of seizures varies from 20 to 70 % with the highest incidence in low- grade gliomas ( 60–70 % ) 1 . There is an increasing use of systemic chemotherapy in patients with brain tumours , and this raises the concern on the potential of substantial interactions between AEDs and anti-neoplastic agents . Phenytoin , carbamazepine , phenobarbital , and to a lesser extent valproate , oxcarbazepine and topiramate , are metabolised by the hepatic cytochrome P-450 system , 
    Output:
    
The efficacy of prophylaxis with levetiracetam seems to be superior to that with phenytoin and valproate administration .
Moreover , levetiracetam use demonstrates fewer side effects in brain tumour patients .