Incidence and management of late postsurgical seizures in clinical practice.

Abstract

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.

Postoperative Epileptic Seizures in Children

“…Such an early onset has been explained by taking into account possible pathogenic mechanisms, hyponatremia, brain manipulation, or immediate surgical complications which would account for early postoperative epileptogenic damage. The prevalence of immediate/early seizures (73.4%) over late seizures (26.6%) in our study, compared with similar series where this relationship is inverse [ 16 , 35 ], can be explained once again by the adopted exclusion criteria, favoring the detection of purely “surgery-induced” seizures.…”

Efficacy and safety of prophylactic levetiracetam in supratentorial brain tumour surgery: a systematic review and meta‐analysis

“…Of the 32 full‐text articles excluded, four concerned patients under LEV, in which it was impossible to retrieve data regarding safety and efficacy , three concerned patients under LEV who underwent craniotomy, but data regarding the perioperative period were not described , four were excluded because patients receiving LEV did not undergo craniotomy , one study was excluded because patients did not received LEV , one was excluded because patients received a combination of LEV with PHT and one study was excluded because the authors enrolled patients under the age of 18 .…”

“…Conversely, late seizures present beyond the first week after surgical intervention and constitute actual epilepsy . The development of postoperative epilepsy, after supratentorial craniotomy for brain tumour biopsy of excision, has an adverse impact on postoperative clinical course and neurological outcome, cost of hospitalization, and rehabilitation . Thus, the control of perioperative seizures is of utmost importance for outcome optimization in this population.…”

Seizure incidence in the acute postneurosurgical period diagnosed using continuous electroencephalography

“…42,43 Although some studies have focused on the acute phase after surgery, 2,3,9,11,12,19,[22][23][24]28,29,31,35,[37][38][39]50 they did not use cEEG monitoring, similar to others in which postneurosurgical seizures were studied in the subacute to chronic postoperative period. 1,4,5,15,20,25,30,33,41,52 cEEG is particularly vital in patients who undergo anesthetic or sedative treatment that can mask the neurological examination findings, 22 and make abnormal, nonseizure-related rhythmic movements difficult to differentiate from clinical seizures. Although some studies evaluating seizures in neurosurgical patients did use cEEG, 7,10,18,26,40,45,46,48 they were narrow in their focus, did not differentiate the acute time period, included a small cohort, or omitted significant details regarding the type of surgery or underlying neuropathology.…”