Reply to Koekkoek et al. concerning SNO and EANO practice guideline update

We appreciate the interest in our updated practice guidelines on antiepileptic drug (AED) prophylaxis in brain tumor patients.¹ Our primary goal was to provide neurologists, neurosurgeons, and neuro-oncologists with an updated guideline on how to utilize AEDs in this particular population. The update and literature search were guided by clinical questions specific to brain tumor patients, and ultimately limited by the lack of high-quality studies addressing the specific questions. As Koekkoek et al. state, the management of seizures is guided by multiple considerations, including efficacy, drug-drug interactions, and side-effect profiles. While these considerations guide everyday clinical decision making, evaluating each one of these was beyond the scope of the seizure guideline update. Fortunately, many new efforts and even some randomized trials are underway to establish high-level evidence that might guide future decision making. We appreciate the authors’ efforts to highlight these in their letter to the editor and identify additional references^2,3 that may be of interest that were published after our guidelines.

Conflict of interest statement. T.W. received honoraria for advisory board participation from Orbus and Tocagen, carried out consulting work for Novocure, and received speaker fees from AstraZeneca. E.R.G. has declared no disclosures.