Antiseizure medication use after meningioma resection: A single institution experience

doi:10.21203/rs.3.rs-2003083/v1

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Antiseizure medication use after meningioma resection: A single institution experience

https://doi.org/10.21203/rs.3.rs-2003083/v1

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Objective: The objective of this study was to investigate the antiseizure medication (ASM) practice behavior at a single institution with regards to type, dosage, and frequency in patients who present with seizures prior to meningioma resection and to review post-operative ASM management.

Methods: A retrospective study of 112 consecutive patients with meningiomas who underwent resection at a single institution between October 2016 and January 2020. Data was collected through detailed chart review, and included demographics, pre-and post-operative seizure characteristics, and type, dose, frequency, and changes to ASM regimens.

Results:Thirty-five patients (31%) had a preoperative seizure, and 43 (38%) of patients were prescribed a preoperative ASM. At discharge, 96 (86%) of patients were prescribed an ASM, which was most often 1000 mg daily total of levetiracetam (64%, 61/96), and less often higher doses of levetiracetam or other ASMs. By the six-month postoperative visit, 55 (49%) of patients were taking at least one ASM, and this number of patients further decreased to 45 (40%) and 36 (32%) by one-year follow-up and last-known follow-up, respectively. Median time to last follow-up was 27.3 months (range = 5.4 – 57.4 months), and by last follow-up, 24 (21%) of patients had experienced a post-operative seizure, and 36 (32%) of patients were never able to discontinue their ASMs.

Conclusions: Most patients who underwent surgical resection of their meningioma were eventually able to completely discontinue their postoperative ASM regimen. However, a large minority of patients continued to experience postoperative seizures throughout their treatment course and required long-term management.

meningioma

antiseizure medication

postoperative seizures

Meningiomas account for 39.0% of all primary brain tumors and central nervous system tumors, making them the most frequently diagnosed primary brain tumor[1]. A common presenting symptom of meningiomas are seizures, and seizures can persist after therapy[2]. Seizures are a major detriment to patient quality-of-life, both acutely and chronically, and are treated with antiseizure medication (ASM). Some of the most commonly administered ASMs are phenytoin, levetiracetam, and valproic acid[3]. Levetiracetam is a more modern ASM and is generally the preferred first-line ASM for patients experiencing seizures as a result of a meningioma or after a meningioma resection because it is at least as effective at controlling seizures with significantly fewer side effects than other ASMs[4–6].

Two distinct time periods in which antiseizure medications may be prescribed to a patient with meningioma are preoperative and postoperative. Preoperative antiseizure medication usage refers to the practice of prescribing ASMs before a patient undergoes surgical resection for their meningioma. The decision to prescribe preoperative ASMs is difficult because they can induce side effects that impact patient quality of life, and they can fail to prevent post-operative seizures, especially with seizure naïve patients[7–9]. Postoperative antiseizure medication usage refers to the usage of ASM after a patient experiences a seizure after the meningioma has been resected. Certain risk factors have been identified as being strong predictors of postoperative seizures, including continuation of ASMs, history of preoperative epilepsy, peritumoral edema, skull base tumor location and epileptiform discharges on postoperative electroencephalogram[7, 10, 11]. Thus, when those risk factors are identified with a particular patient, ASM use is commonly utilized postoperatively. In practice, there are varying optimal dosages for different ASMs which are used both preoperatively and postoperatively, and overall there is no consensus on medication practice behavior for ASM administration, with ASM usage varying by institution[12]. Furthermore, while previous studies often report the proportion of patients who are prescribed different types of ASMs[13, 14], the doses of those ASMs, and how they change over time post-operatively, are not typically discussed. This study will investigate the medication practice behavior at a single institution in order to elucidate whether or not there is a foundational basis for a consensus moving forward. Through our investigation of the medication practice behavior, trends regarding ASM type, dose, and frequency will be determined along with establishing ASM usage throughout patients’ clinical course after meningioma resection.

We performed a retrospective analysis of a cohort of 112 patients with meningiomas who underwent resection at a single institution between October 2016 and January 2020. Patient demographics, pre- and post-operative seizure characteristics, as well as pre- and post-operative anti-seizure medication (ASM) characteristics were analyzed in this study. Patients were excluded from analysis if they had multiple meningiomas, were undergoing repeat resection, or did not have at least one year of complete follow-up information. This study was approved by the institutional review board, and informed consent was obtained from all individual participants of this study.

Patients’ age, sex, date of meningioma identification, and whether the patient was undergoing a repeat resection were collected as demographic information. For patients with preoperative seizures, information was collected regarding date of seizure onset, type of preoperative seizure, frequency of preoperative seizures, duration of seizures prior to resection, and total number of preoperative seizures. For patients with postoperative seizures, information was collected regarding postoperative seizure type, frequency, date of onset, and Engel Classification[15] at two-weeks, 6-months, 1-year, and last-known postoperative clinic visits. Postoperative paroxysmal events were classified as seizure recurrences if clinical notes indicated high suspicion for seizures and events were controlled with changes made to ASM regimen. Whether or not patients received ASMs was determined utilizing a combination of medication records and clinical notes. For the preoperative, perioperative, and postoperative periods, we assessed type, dose, and frequency of ASMs. At each postoperative clinic visit, we assessed whether changes had been made to patients’ ASM regimens and the rationale for such changes.

Preoperative Period & Discharge:

Of the 112 patients included in our study, the mean age at time of resection was 56.3 years and 68.8% (n=77) of patients were female (Table 1). Most patients had supratentorial meningiomas (94%, n=105), though both supra- and infratentorial meningiomas were included for analysis. Overall, 38.4% (n=43) patients were prescribed at least one ASM prior to undergoing tumor resection. Preoperative seizures occurred in 31.3% (n=35) of all patients, and of those patients, 74.3% (n=26/35) were prescribed an ASM. The most common pre-operative ASM regimen was levetiracetam 1000 mg total (62.8%, n=27/43). Nine patients (26.5%, n=9/34) were taking 1250-2000 mg total levetiracetam monotherapy, and 20.6% (n=7/34) were taking other ASM regimens, which consisted of higher than 2000 mg levetiracetam and/or other ASMs. Those who were prescribed doses higher than 1000 mg total of levetiracetam included patients who experienced focal seizures without loss of awareness, focal seizures with loss of awareness, and secondarily generalized seizures. Dosing information for additional ASMs is included in Table 2. Of the 77 patients who did not have a preoperative seizure, 77.9% (n=60) did not receive an ASM pre-operatively.

Table 1

Patient Demographics and Characteristics

Demographics and Characteristics
Age at resection, median (range)	57 (27 – 85)
Sex, n (%)
Female	77 (68.7)
Male	35 (31.3)
Tumor Location, n (%)
Convexity/Parasagittal/Falx	51 (45.9)
Skull base	60 (54.1)
Pre-operative seizure, n (%)	35 (31.3)
Post-operative seizure, n (%)	24 (21.4)
Median months to last follow-up (range)	27.3 (5.4 – 57.4)

Table 2

Preoperative antiseizure medication regimens

ASM category	ASM regimen	Dose
1000 Lev (n=27)	Levetiracetam (n=27)	500 BID (n=27)
1250-2000 Lev (n=9)	Levetiracetam (n=9)	1000 BID (n=6); 750 BID (n=3)
Other (n=7)	Carbamazepine (n=1)	200 BID (n=1)
	Carbamazepine/Lacosamide/ Levetiracetam/Lorazepam (n=1)	200 BID / 200 BID / 1000 BID / 1 QD (n=1)
	Carbamazepine/Topiramate (n=1)	400 BID / 175 (75am/100pm) (n=1)
	Clonazepam (n=1)	0.25 QD (n=1)
	Clonazepam/Levetiracetam/ Topiramate (n=1)	0.5 PRN / 1500 BID / 100 BID (n=1)
	Gabapentin (n=1)	600 TID (n=1)
	Topiramate (n=1)	50 QD (n=1)
None (n=69)	None (n=69)	-

ASM = antiseizure medication; BID = twice a day; Lev = levetiracetam; PRN = as needed; QD = once a day; TID = three times a day

At discharge following surgical resection of their meningioma, 85.7% (n=96) of patients were prescribed at least one ASM. Every patient (35/35) who experienced a preoperative seizure were prescribed an ASM at discharge, which was most frequently levetiracetam (97.1%, n=34/35), and a majority of patients (79.2%, n=61/77) who never experienced a preoperative seizure were also discharged with an ASM. Of the patients who received an ASM, 90.6% (n=87/96) were prescribed levetiracetam monotherapy, and the most common ASM regimen at discharge was levetiracetam 1000 mg total (63.5%, 61/96). The remainder of the patients who were taking an ASM were either taking 1250-2000 mg total levetiracetam monotherapy (26.0%, n=25/96) or another ASM regimen (10.4%, n=10/96). For the patients who were prescribed levetiracetam 2000 mg total at discharge, 8 had at least one seizure prior to surgery, 7 patients had no seizures prior to surgery and no seizures during the index hospitalization, and one patient had no seizures prior to surgery but did have seizures during the index hospitalization. Additional dosing information for each ASM is included in Table 3.

Table 3

Discharge antiseizure medication regimens

ASM category	ASM regimen	Dose
1000 Lev (n=61)	Levetiracetam (n=61)	500 BID (n=61)
1250-2000 Lev (n=25)	Levetiracetam (n=25)	1000 BID (n=16); 750 BID (n=9)
Other (n=10)	Lacosamide (n=2)	100 BID (n=1); 50 BID (n=1)
	Topiramate (n=2)	175 QD (n=1); 50 QD (n=1)
	Carbamazepine (n=1)	200 BID (n=1)
	Clonazepam/Levetiracetam (n=1)	0.25 QD / 500 BID (n=1)
	Gabapentin (n=1)	100 TID(n=1)
	Gabapentin/Levetiracetam (n=1)	300 TID / 500 BID (n=1)
	Levetiracetam (n=1)	2000 BID (n=1)
	Lorazepam (n=1)	0.5 TID (n=1)
None (n=16)	None (n=16)	-

ASM = antiseizure medication; BID = twice a day; Lev = levetiracetam; QD = once a day; TID = three times a day

Initial Postoperative Visit:

At the initial postoperative clinic visit (median days postop = 16), 76.8% of all patients (n= 86) were taking at least one ASM. Of these patients, 58.1% (50/86) were taking 1000 mg total levetiracetam, 24.4% (21/86) were taking 1250-2000 mg total levetiracetam, and 17.4% (15/86) were taking other ASM regimens. The ASM regimen for the majority of patients (77.7%, n=87) remained unchanged from discharge. However, 12 patients were able to end their ASMs, and 1 patient was able to lower their dosage of ASM. On the other hand, 12 patients had to increase their ASM dosage or add additional ASMs to their monotherapy levetiracetam regimen, which was most often due to breakthrough post-operative seizures. Additional dosing information for each ASM is included in Table 4.

Table 4

Initial post-operative antiseizure medication regimens

ASM category	ASM regimen	Dose
1000 Lev (n=50)	Levetiracetam (n=50)	500 BID (n=50)
1250-2000 Lev (n=21)	Levetiracetam (n=21)	1000 BID (n=17); 750 BID (n=4)
Other (n=15)	Levetiracetam (n=4)	1500 BID (n=4)
	Gabapentin/Levetiracetam (n=2)	300 TID / 500 BID (n=1); 100 BID+300nightly / 1000 BID (n=1)
	Carbamazepine/Gabapentin/ Levetiracetam (n=1)	200 BID / 300 TID / 1000 BID (n=1)
	Carbamazepine/Lacosamide/ Levetiracetam/Lorazepam (n=1)	200 BID / 200 BID / 3500 (1500am/2000pm) / Q6 PRN (n=1)
	Carbamazepine/Topiramate (n=1)	300 BID / 175 (75am/100pm) (n=1)
	Clonazepam/Levetiracetam (n=1)	0.25 PRN / 500 BID (n=1)
	Clonazepam/Lacosamide/ Levetiracetam/ Phenytoin (n=1)	0.5 QD / 200 BID / 2000 BID/ 100 TID (n=1)
	Clonazepam/Levetiracetam/ Topiramate (n=1)	0.5 PRN / 1000 BID / 150 BID (n=1)
	Lacosamide (n=1)	50 BID (n=1)
	Lacosamide/Levetiracetam (n=1)	100 BID / 1000 BID (n=1)
	Topiramate (n=1)	50 QD (n=1)
None (n=26)	None (n=26)	-

ASM = antiseizure medication; BID = twice a day; Lev = levetiracetam; PRN = as needed; QD = once a day; TID = three times a day

Six-Month and One-Year Postoperative Visit:

At the six-month visit (median days postop = 191), 49.1% of patients (n= 55) were taking at least one ASM. Of these patients, 47.3% (n=26/55) were taking 1000 mg total levetiracetam, 29.1% (n=16/55) were taking 1250-2000 mg total levetiracetam, and 23.6% (n=13/55) were taking other ASM regimens. Of the 86 patients who were taking an ASM at the initial postoperative visit, 31 (36.0%) were able to end their ASM regimens completely, 4 (4.7%) were able to decrease their ASM regimen, 5 (5.8%) changed their ASM regimen due to side effects of their previous ASM, and 4 (4.7%) had to increase their ASM dosage. Additional ASMs and dosage information for this visit can be found in Table 5.

Table 5

Six-month post-operative antiseizure medication regimens

ASM category	ASM regimen	Dose
1000 Lev (n=26)	Levetiracetam (n=26)	500 BID (n=26)
1250-2000 Lev (n=16)	Levetiracetam (n=16)	1000 BID (n=12); 750 BID (n=4)
Other (n=13)	Lacosamide (n=4)	150 BID (n=3); 50 BID (n=1)
	Carbamazepine/Gabapentin/ Levetiracetam (n=1)	200 BID / 100 BID / 750 BID (n=1)
	Clonazepam/Levetiracetam/ Phenytoin (n=1)	0.5 QD / 1500 BID / 500 (200/300) (n=1)
	Gabapentin (n=1)	300 TID (n=1)
	Lacosamide/Lamotrigine/ Topiramate (n=1)	200 BID / 200 BID / 250 (100am/150pm) (n=1)
	Lacosamide/Levetiracetam/ Lorazepam (n=1)	200 BID / 3500 (1500am/2000pm) / 1 Q6 PRN (n=1)
	Lamotrigine/Levetiracetam (n=1)	25 BID / 750 BID (n=1)
	Levetiracetam (n=1)	1500 BID (n=1)
	Levetiracetam/Topiramate (n=1)	750 BID / 50 BID (n=1)
	Topiramate (n=1)	50 QD (n=1)
None (n=57)	None (n=57)	-

ASM = antiseizure medication; BID = twice a day; Lev = levetiracetam; PRN = as needed; Q6 = six times a day; QD = once a day; TID = three times a day

At the one-year postoperative visit (median days postop= 394), 40.2% (n= 45) of all patients were taking at least one ASM. Of these patients, 48.9% (22/45) were taking 1000 mg total levetiracetam, 20.0% (9/45) were taking 1250-2000 mg total levetiracetam, and 31.1% (14/45) were taking other ASM regimens. While 12 patients were able to end their ASMs since their 6-month postoperative visit, and 6 patients were able to decrease their dosage of ASMs, 11 had to increase their ASM dosage, mostly due to post-operative seizures, and 2 had to change their ASM regimen due to side effects. Additional ASMs and dosage information for this visit can be found in Table 6.

Table 6

One-Year post-operative antiseizure medication regimens

ASM category	ASM regimen	Dose
1000 Lev (n=22)	Levetiracetam (n=22)	750 QD (n=1); 500 BID (n=19); 250 BID (n=2)
1250-2000 Lev (n=9)	Levetiracetam (n=9)	1000 BID (n=5); 1250 (500am/750pm) (n=1); 750 BID (n=3)
Other (n=14)	Lacosamide (n=4)	150 BID (n=3); 100 BID (n=1)
	Levetiracetam (n=3)	1500 BID (n=3)
	Clobazam/Lacosamide/ Lamotrigine/Topiramate (n=1)	15 BID / 200 BID / 550 (300am/250pm) / 75 BID (n=1)
	Clonazepam/Levetiracetam/ Phenytoin (n=1)	0.5 QD / 750 BID / 500 (200am/300pm) (n=1)
	Gabapentin (n=1)	300 TID (n=1)
	Lacosamide/Levetiracetam/ Lorazepam (n=1)	200 BID / 3500 (1500am/2000pm) / 1 Q6 PRN (n=1)
	Lamotrigine/Levetiracetam (n=1)	200 BID / 1000 BID (n=1)
	Levetiracetam/Topiramate (n=1)	750 BID / 25 BID (n=1)
	Topiramate (n=1)	50 QD (n=1)
None (n=67)	None (n=67)	-

ASM = antiseizure medication; BID = twice a day; Lev = levetiracetam; PRN = as needed; Q6 = six times a day; QD = once a day; TID = three times a day

Last Known Follow Up:

The median time to last known follow up was 832 days postoperatively. At the last known follow up visit, 32.1% (n=36) of patients remained on at least one ASM. Of these patients, 36.1% (13/36) were taking 1000 mg total levetiracetam, 25% (9/36) were taking 1250-2000 mg total levetiracetam, and 38.9% (14/36) were taking other ASM regimens. Since their one-year postoperative visit, 12 patients were able to end their ASMs, but 7 had to increase their ASM regimen, which for 5 patients was due to continued seizures on their prior regimen. Additional ASMs and dosage information for this visit can be found in Table 7.

Table 7

Last follow-up post-operative antiseizure medication regimens

ASM category	ASM regimen	Dose
1000 Lev (n=13)	Levetiracetam (n=13)	500 BID (n=13)
1250-2000 Lev (n=9)	Levetiracetam (n=9)	2000 QD (n=1); 1000 BID (n=4); 1250 (500am/750pm) (n=2); 750 BID (n=2)
Other (n=14)	Lacosamide (n=4)	150 BID (n=3); 100 BID (n=1)
	Levetiracetam (n=2)	1500 BID (n=2)
	Brivaracetam/Clonazepam (n=1)	50 BID / 1 PRN
	Clobazam (n=1)	35 (15am/20pm) (n=1)
	Gabapentin (n=1)	300 TID (n=1)
	Gabapentin/Lacosamide/ Levetiracetam/Lorazepam (n=1)	300 QD / 200 BID / 3500(1500am/2000pm) / 1 Q6 PRN
	Lamotrigine/Levetiracetam (n=1)	225 BID / 500 BID (n=1)
	Levetiracetam/Topiramate (n=1)	1000 BID / 200 QD (n=1)
	Phenytoin (n=1)	300 BID (n=1)
	Topiramate (n=1)	50 QD (n=1)
None (n=76)	None (n=76)	-

ASM = antiseizure medication; BID = twice a day; Lev = levetiracetam; PRN = as needed; Q6 = six times a day; QD = once a day; TID = three times a day

By last follow-up, 21.4% (n=24) of patients had experienced a post-operative seizure, and 77.7% (n=87) were completely seizure free since surgery. Of the 35 patients with a pre-operative seizure, 40.0% (14/35) had a post-operative seizure, and of the 77 patients who never experienced a pre-operative seizure, 13.0% (10/77) subsequently had a post-operative seizure. Six patients had a post-operative seizure between discharge and their initial post-operative visit, 13 patients had a seizure between their initial post-operative visit and the 6-month visit, 11 patients had a seizure between their 6-month visit and the 1-year visit, and 8 patients had a seizure between their 1-year visit and last follow up, with some of those patients having seizures during multiple of those time points.

Overall, 67.9% (n=76) of all patients were not taking ASMs by last follow-up, with 55.4% (n=62) of patients having taken ASMs post-operatively but then were subsequently able to discontinue all ASMs, and 12.5% (n=14) of patients were never prescribed ASMs and never subsequently required them. On the other hand, 13.4% (n=15) of patients were always on the same regimen of ASMs at all time-points post-operatively, and 18.8% (n=21) of patients required an ASM regimen change due to post-operative seizures or side effects, and were never able to subsequently able to discontinue their ASMs. Changes in anti-seizure medication regimens over time in this patient population are summarized in Figure 1.

Despite that meningiomas are the most common central nervous system tumors, and frequently present with seizures, the best medication practice behavior for antiseizure medication in this population remains unclear. A contributing factor to this lack of consensus is limited information on how ASM type, dose, and frequency are managed throughout a patient’s treatment course, both preoperatively and postoperatively.

In this study, 38.4% of patients (n = 43/112) were prescribed a pre-operative ASM, and of these patients, most (60.5%, n = 26/43) had a pre-operative seizure. Following surgical resection of their meningioma, a vast majority of patients (85.7%, n = 96) were discharged with an ASM. There remains unclear guidance on the proper approach for ASM prophylaxis after surgical resection of meningioma, although the rates of patients receiving ASM in this study were comparable to those reported elsewhere. An analysis of 5 years of pharmacy claims data demonstrated that 61.9% of patients who underwent surgical resection of their meningioma received ASM prophylaxis[12]. While a majority of patients in this study were taking ASM prophylaxis at discharge, many of them were able to eventually wean off of and completely end their ASMs. The interval in which the most patients were able to wean off their ASMs was between the initial post-operative visit and their 6-month post-operative visit, during which 35 patients either completely discontinued (n = 31) or decreased (n = 4) their ASM regimens.

However, a sizeable proportion of patients required long-term management of their ASM regimens. Thirty patients (26.8%) needed their ASM dosage to be increased or their ASM regimen to be modified, often due to breakthrough post-operative seizures or side effects of previous ASM regimens. Overall, 32.1% (n = 36) of patients were never able to discontinue their ASMs by last follow-up. While the overall percentage of patients taking an ASM dropped from 85.7% at discharge to 32.1% at long-term follow-up, the complexity of these ASM regimens changed over time. At discharge, 63.5% (n = 61/96) of patients who were taking an ASM were taking 1000 mg total of levetiracetam, yet at last follow-up, only 36.1% (n = 13/36) patients of patients taking an ASM were taking 1000 mg total of levetiracetam. The majority of ASM regimens were either higher doses of levetiracetam (30.6%, n = 11/36) or single or multi-modal ASM regimens (36.1%, n = 13/36). A large contributing factor to this shift in ASM regimens over time is that the patients who still required seizure prophylaxis long into their treatment course required higher doses of ASMs to do so.

In total, 41.1% (n = 45) of all patients in this study had experienced a seizure at some point during their disease course, either pre-operatively and/or post-operatively. Thirty-one percent of patients in this study experienced a pre-operative seizure, which is similar to the rate of 29% reported in a large meta-analysis[10]. After surgical resection, 21% of patients in this study had a post-operative seizure, which is comparable to the rates of 26%[14] and 14%[13] reported in two other studies. While 6 of the 24 patients (25.0%) who had a post-operative seizure had their first post-operative seizure after discharge and before their initial post-operative visit, a majority had their first post-operative seizure at later time points. Eleven patients (44.0%) had their first post-operative seizure after their initial post-operative visit and before their 6-month visit, 5 (20.0%) had their first post-operative seizure after their 6-month visit and before their 1-year visit, and 2 (8.0%) had their first post-operative seizure after their 1-year visit. This delayed incidence of post-operative seizures, in addition to the fact that 41.7% (n = 10/24) of patients with post-operative seizures never had a pre-operative seizure, highlights the need for long-term management and observation of patients with meningiomas to properly address tumor-associated epilepsy in this population.

Our study has several limitations. This was a retrospective chart review study, which has several inherent limitations including availability and accuracy of patient and tumor information. In addition, the rationale guiding decision making for modification in antiseizure medication dosing or regimen is unknown. While the objective data is available retrospectively, it is often unclear based on chart review why there was a change in medication regimen. Information on seizures, both pre-operative and post-operative, are limited to recall of patients and documentation of care providers. Finally, this study was performed at a single institution, which reduces the external generalizability of the results. Future studies should prospectively examine the rationale driving modifications in antiseizure medication dosing and regimen. It is clear that there is both a lack of guidance and variable approaches to antiseizure medication regimen after meningioma resection, and a generalizable algorithm is warranted.

A vast majority of patients with meningiomas were prescribed antiseizure medication postoperatively, and most of those patients were able to eventually completely discontinue their ASM regimen. However, a large minority of patients continued to experience postoperative seizures throughout their treatment course that required long-term management.

Ethical Approval and Consent to participate: The protocol of the study did not require approval by the ethical committees. No consent to participate was required as it was an observational study.

Human and Animal Ethics: This is an observational study under IRB STU00214702. No ethical committee approval was required.

Consent for publication: Not applicable

Availability of supporting data: Not applicable

Competing Interests: The authors have no relevant financial or non-financial interests to disclose.

Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Authors’ Contributions: All authors contributed substantially to the conception and design of this project. Material preparation and data collection were performed by Erin M. Ellis, Jonathan Huang, and Samhitha Rai. Data analysis was performed by Erin M. Ellis and Michael R. Drumm. The first draft of the manuscript was written by Erin M. Ellis and Samhitha Rai, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Acknowledgements: None

Authors’ information:

Erin M. Ellis, BA

Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America

[email protected]

Michael R. Drumm, BA

Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America

[email protected]

Samhitha Rai

University of Illinois Chicago, Chicago, Illinois, United States of America

[email protected]

Jonathan Huang, BS

Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America

[email protected]

Matthew C. Tate, MD, PhD

Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America

[email protected]

Stephen T. Magill, MD, PhD

Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America

[email protected]

Jessica W. Templer, MD

Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America

[email protected]

ORCID ID: 0000-0003-1850-8868

Previous Presentations:

An abstract for this paper was presented as a poster at the University of Illinois Chicago Undergraduate Research Forum on April 6, 2022, and the Chicago Area Undergraduate Research Symposium on April 9, 2022.

Funding

Author Stephan T. Magill is supported by the Northwestern Medicine Malnati Brain Tumor Institute of the Lurie Cancer Center.

The authors declare that this project has not been supported by funding from any source.

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No competing interests reported.

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Antiseizure medication use after meningioma resection: A single institution experience

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