BACKGROUND:In 2000, the American Academy of Neurology guidelines recommended that long-term seizure prophylaxis should not be routine in patients with newly diagnosed brain tumours and that if anti-epileptic drugs (AEDs) are used, they should be tapered and discontinued after 7 days post-operatively. Recent data shows that most newly diagnosed brain tumour patients continue to receive prophylactic AED. AIM: This study aimed to examine the seizure prophylaxis practices at Trillium Health Partners -Mississauga Hospital, a regional neurosurgery centre located in Mississauga, Ontario, Canada.
MATERIALS AND METHODS:A retrospective chart review was performed in adult patients with a newly diagnosed brain tumour who underwent neurosurgery between January 2010 and December 2014. RESULTS: 690 patient charts were screened and 235 patients were excluded, most commonly due to seizure on admission. Overall, 28% (n = 129) of 455 included patients over 5 years received seizure prophylaxis. Phenytoin was the most common prophylactic agent used. The average post-operative length of stay was 7.98 days and the average duration of therapy was 8.73 days. In 61% of patients who received prophylaxis, it was unknown whether the AED was continued in the long-term. The drug cost savings to the organization over 5 years if patients had not received seizure prophylaxis was $ 4287.52. The patient characteristics most strongly correlated with receiving seizure prophylaxis were increasing tumour size and decreasing number of tumours. CONCLUSION: 1 in 3 patients at Trillium Health Partners received seizure prophylaxis. Increased awareness of the organization's practice patterns may help prevent unnecessary long-term AED use.Key words: Seizure; Prophylaxis; Neurosurgery; Adherence; Guidelines; Anti-epileptic Drugs
INTRODUCTIONIn Canada, 55,000 patients live with a brain tumour and an additional 10,000 patients are newly diagnosed with a primary or metastatic brain tumour each year [1] . Brain tumours are associated with high morbidity and mortality rates, therefore effective treatment is necessary to decrease both morbidity and mortality. However, treatment for brain tumours is complicated by their vast diversity in pathology, location and recurrence rate [1] . Seizure is a common and debilitating complication for brain
ORIGINAL ARTICLE
Analysis of the Adherence to Seizure Prophylaxis Guidelines in Neurosurgery PatientsXueqing ( International Journal of Neurology Research tumour patients, due to physical injury, emotional stress, anxiety, and impaired activities of daily living [2,3] . Up to half of patients with brain tumours present to hospital with seizure as a manifestation of the disease, and another 10-30% will develop seizures [4,5] . Seizures resulting from brain tumourssignificantly decrease patients' quality of life [6] . Antiepileptic drugs (AEDs) have traditionally been used to both treat and prevent seizures in brain tumourpatients. The majority of research conducted supports the usage of AED to prevent seizures in brain ...