Epilepsy after Craniotomy and the Place of Prophylactic Anticonvulsant Drugs: Discussion Paper

Shaw, M.; Foy, P. M.

doi:10.1177/014107689108400412

Cited by 63 publications

(62 citation statements)

References 9 publications

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“…Pre-operative seizures attained 1/3 of study population and was comparable to frequency reported in other studies (2,12,16), while this study cohort had more early seizures than previous reports (11,12). Early seizures represent a well known risk factor for postsurgical epilepsy, as they correlate with the severity of the cerebral insult (14,20). In our study cohort incidence of late seizures (46% of study population) was quite elevated, occurring either in patients who had never experienced seizures before surgery and in subjects with pre-operative and early seizures.…”

Section: Discussionmentioning

confidence: 71%

“…within 1 week from procedure) or late seizures (i.e. beyond 1 week) (7,20). Early seizures are the acute symptomatic ones, depending on the immediate post-traumatic effect of the neurosurgical procedure (e.g.…”

mentioning

confidence: 99%

“…Hence the possibility of postoperative seizure prophylaxis and therapy is more than desirable. The role of Anti Epileptic Drugs (AEDs) in risk reduction is debated (14,20). While antiepileptic treatment of seizures is mandatory, the advantage of prophylaxis with AEDs has not been clearly assessed.…”

mentioning

confidence: 99%

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Incidence and management of late postsurgical seizures in clinical practice.

Bartolini¹,

Lenzi²,

Vannozzi³

et al. 2012

Turkish Neurosurgery

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AIm: Seizures are a frequent complication in patients who undergo neurosurgery, and can complicate the post-operative course and deteriorate patients' quality of life. Evidence on the prophylactic anticonvulsant therapy after craniotomy is still lacking. mATeRIAL and meTHods:We undertook an observational longitudinal study following neurosurgical supratentorial interventions, to evaluate seizures onset or persistence, and differences in effectiveness between conventional and newer AEDs. ResuLTs:A total of 100 consecutive subjects were enrolled. Each patient underwent a neurosurgical treatment by craniotomy. Pre-operative seizures occurred in 33% patients, early seizures in 13%. Late seizures occurred in 46 patients. At baseline (1 month after surgery) and during follow up the main therapeutic regimen was monotherapy. At last follow up adjustment of antiepileptic regimen or AED dosage had rendered 27 subjects seizure free. People taking newer AEDs at baseline maintain the same antiepileptic regimen more often than patients taking conventional AEDs; late seizures tended to have a higher incidence in the latter group. Adverse events from baseline AEDs were reported by 17% of patients. CoNCLusIoN:In this study population late postsurgical seizures had a remarkable occurrence. Newer AEDs were continued more often than conventional AEDs, with a better tolerability but no significant differences in late seizures incidence. BuLGuLAR: Çalışmaya arka arkaya toplam 100 hasta kaydedildi. Her hastada kraniyotomi şeklinde bir nöroşirürji tedavisi gerçekleştirildi. Preoperatif havaleler hastaların %33'ünde ve erken havaleler %13'ünde görüldü. Geç havaleler 46 hastada görüldü. Başlangıçta (cerrahiden 1 ay sonra) ve takip sırasında ana terapötik rejim monoterapiydi. Son takipte antiepileptik rejim veya antiepileptik ilaç dozunun ayarlanmasıyla 27 hastada havaleler ortadan kaybolmuştu. Başlangıçta daha yeni antiepileptik ilaçları alan kişilerde geleneksel antiepileptiklere göre daha sık olarak aynı antiepileptik rejime devam edildiği görüldü; geç havalelerin insidansı ikinci grupta daha yüksekti. Başlangıç antiepileptik ilaçlar nedeniyle advers olaylar hastaların %17'sinde bildirildi. soNuÇ: Bu çalışma, popülasyonunda cerrahi sonrası geç havalelerin insidansı önemli ölçüdeydi. Daha yeni antiepileptik ilaçlar geleneksel antiepileptiklere göre daha sık devam edildi ve daha iyi tolere edildiler ama geç havale insidansında önemli bir fark yoktu.

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Section: Discussionmentioning

confidence: 71%

mentioning

confidence: 99%

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Incidence and management of late postsurgical seizures in clinical practice.

Bartolini¹,

Lenzi²,

Vannozzi³

et al. 2012

Turkish Neurosurgery

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“…Depending on the reason for surgery, up to 50% patients have at least one seizure treated postoperatively (Shaw & Foy, 1991). There are no formal guidelines for routine seizure prophylaxis after neurosurgery in general.…”

Section: Seizure Management and Prophylaxismentioning

confidence: 99%

Neuro Critical Care

Majumdar¹

2012

Explicative Cases of Controversial Issues in Neurosurgery

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“…The overall incidence of postoperative epilepsy was 17% in a study of 1000 patients who had undergone supratentorial neurosurgery with prolonged follow up. 69) The incidence varied with different pathologies ranging from 3% for Frazier's operation to 92% for abscess as shown in Table 1.…”

Section: Risk Of Postoperative Seizuresmentioning

confidence: 99%

Postoperative Seizures: Epidemiology, Pathology, and Prophylaxis

Manaka

Ishijima

Mayanagi

2003

Neurol. Med. Chir.(Tokyo)

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The risk of epileptic seizures after craniotomy is extremely important but the incidence of postoperative epilepsy varies greatly, depending on the patient's conditions such as primary diseases, severity of surgical insult, and pre-existing epilepsy. Animal studies suggest that neurosurgical insults lead to seizures by two different mechanisms: One mechanism is mediated by free radical generation and the other by impaired ion balance across the cell membrane caused by ischemia or hypoxia. Conventional antiepileptic agents such as phenytoin, phenobarbital, carbamazepine, and valproic acid are promising for the prevention of early seizures, but the effect in preventing postoperative epilepsy is still controversial. Studies on the prophylactic effect of newer antiepileptic agents in craniotomized patients were very limited. Zonisamide, an antiepileptic agent with antiepileptogenic, free radical scavenging and neuroprotective actions in experimental animals, showed promising effects against postoperative epilepsy in a randomized double blind controlled trial. Prophylactic treatment for craniotomized patients significantly prevented the development of partial seizures during the follow-up period. Most recent studies have not supported the prophylactic use of antiepileptic agents in craniotomized patients, but further studies are required.

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Epilepsy after Craniotomy and the Place of Prophylactic Anticonvulsant Drugs: Discussion Paper

Cited by 63 publications

References 9 publications

Incidence and management of late postsurgical seizures in clinical practice.

Incidence and management of late postsurgical seizures in clinical practice.

Neuro Critical Care

Postoperative Seizures: Epidemiology, Pathology, and Prophylaxis

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