BRITISH 21craniotomy per se is of little importance in the development of post-operative epilepsy. Cases of middle cerebral aneurysm are more common in the epileptic group, as would be expected in view of the distribution of the middle cerebral artery to the fronto-parietal regions and the frequent development of a haematoma in the temporal lobe or the sylvian fissure. This is comparable to the higher incidence of post-traumatic epilepsy when the fronto-parietal areas are involved (Caveness and Liss, 1961). The patients with epilepsy in this series are younger than the average age for the whole group, but this is explained partly by a loading of cases of middle cerebral aneurysm in the younger age-groups.Fits following subarachnoid haemorrhage are usually generalized, but any type may occur. At the time of the first fit 80% of the epileptics were not taking anticonvulsants, and the remainder were taking only minimal dosage. Five patients had their first fit more than 18 months after the original illness, and three of these after more than two years. Anticonvulsant therapy should therefore be continued for at least two years, and for those at risk three years. The fits were easily controlled with anticonvulsant therapy; relapses were rare once the patients took the drugs, and, apart from an initial mild midday Fits were more likely to occur in the younger age-group, when the aneurysm was situated on the middle cerebral artery, and in the presence of an intracerebral haematoma. Patients with residual signs of brain damage seemed to be particularly at risk. The fits were usually of the grand-mal type, but focal or temporal-lobe epilepsy also occurred, and different types of fit were occasionally seen in the same patient. Five patients had their first fit more than 18 months after the aneurysm had ruptured.At the time of the first fit 80% of the epileptics were not taking anticonvulsants. In most cases the fits were few in number and were well controlled with anticonvulsant therapy. Phenobarbitone, 30 mg. b.d., should be given routinely for two years after all cases of ruptured intracranial aneurysm. In cases particularly at risk-for example, younger patients with a ruptured middle cerebral aneurysm associated with an intracerebral haematoma or evidence of residual brain damagethe dose should be increased to 30 mg. t.d.s. and continued for three years. If the patient has an attack, phenytoin, 100 mg. once to thrice daily, should be added.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.