Epilepsy in chronic subdural haematoma

Rubin, Giorgio; Rappaport, Z. H.

doi:10.1007/bf01476283

Cited by 55 publications

(50 citation statements)

References 37 publications

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“…Two studies reported no significant difference in seizure rate secondary to the prophylactic administration of AEDs [64,73]. Both groups concluded that the morbidity of AED administration outweighs the benefits except in patients at particularly high risk for seizures, such as alcoholics [64,73].…”

Section: Prophylactic Anticonvulsants Following Csdhmentioning

confidence: 95%

“…Therefore, the added risk of recurrent hemorrhage following anticonvulsant treatment must be outweighed by the benefits of AED prophylaxis. Unfortunately, the efficacy of seizure prophylaxis in the setting of both treated and untreated cSDH has been addressed only through a small number of retrospective studies [24,64,73,76].…”

Section: Prophylactic Anticonvulsants Following Csdhmentioning

confidence: 99%

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The surgical management of chronic subdural hematoma

et al. 2011

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Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of post-operative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation. A PubMed search was carried out through October 19, 2010 using the following keywords: "subdural hematoma", "craniotomy", "burr-hole", "management", "anticoagulation", "seizure prophylaxis", "antiplatelet", "mobilization", and "surgical evacuation", alone and in combination. Relevant articles were identified and back-referenced to yield additional papers. A meta-analysis was then performed comparing the efficacy and complications associated with the various methods of cSDH evacuation. There is general agreement that significant coagulopathy should be reversed expeditiously in patients presenting with cSDH. Although protocols for gradual resumption of anti-coagulation for prophylaxis of venous thrombosis may be derived from guidelines for other neurosurgical procedures, further prospective study is necessary to determine the optimal time to restart full-dose anti-coagulation in the setting of recently drained cSDH. There is also conflicting evidence to support seizure prophylaxis in patients with cSDH, although the existing literature supports prophylaxis in patients who are at a higher risk for seizures. The published data regarding surgical technique for cSDH supports primary twist drill craniostomy (TDC) drainage at the bedside for patients who are high-risk surgical candidates with non-septated cSDH and craniotomy as a first-line evacuation technique for cSDH with significant membranes. Larger prospective studies addressing these aspects of cSDH management are necessary to establish definitive recommendations.

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Section: Prophylactic Anticonvulsants Following Csdhmentioning

confidence: 95%

Section: Prophylactic Anticonvulsants Following Csdhmentioning

confidence: 99%

The surgical management of chronic subdural hematoma

et al. 2011

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“…Rubin and Rappaport [102] conducted a retrospective analysis of 143 adult patients treated for CSH from January 1979 to July 1991. Surgeries were performed on 138 patients.…”

Section: Discussionmentioning

confidence: 99%

“…For some experts, the low incidence of seizures does not justify an anticonvulsant prophylaxis in patients with CSH caused by minor head injury [83]. Others suggest that this prophylactic medication should be considered only in alcoholic patients because of their higher risk of seizure [102]. Another study verified a significant increase in morbidity and mortality associated with respiratory complications and status epilepticus in patients with new-onset seizures.…”

Section: Introductionmentioning

confidence: 97%

Prophylactic antibiotics and anticonvulsants in neurosurgery

Ratilal

Sampaio

2011

Advances and Technical Standards in Neurosurgery

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The prophylactic administration of antibiotics to prevent infection and the prophylactic administration of anticonvulsants to prevent first seizure episodes are common practice in neurosurgery. If prophylactic medication therapy is not indicated, the patient not only incurs the discomfort and the inconvenience resulting from drug treatment but is also unnecessarily exposed to adverse drug reactions, and incurs extra costs. The main situations in which prophylactic anticonvulsants and antibiotics are used are described and those situations we found controversial in the literature and lack further investigation are identified: anticonvulsants for preventing seizures in patients with chronic subdural hematomas, antiepileptic drugs for preventing seizures in those suffering from brain tumors, antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures, and antibiotic prophylaxis for the surgical introduction of intracranial ventricular shunts.In the following we present systematic reviews of the literature in accordance with the standard protocol of The Cochrane Collaboration to evaluate the effectiveness of the use of these prophylactic medications in the situations mentioned. Our goal was to efficiently integrate valid information and provide a basis for rational decision-making.

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“…This information greatly favors the use of prophylactic AEDs in acute SDH. Reduction of seizures from the prophylactic use of AEDs in chronic SDH is more controversial [12,13,15,56,57]. Although AEDs are not routinely used in this setting in the absence of a clinical suspicion of seizures, seizures should always be considered when the clinical progress is not as anticipated.…”

Section: Treatmentmentioning

confidence: 97%