Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated?

Sughrue, Michael E.; Rutkowski, Martin J.; Chang, Edward F.; Shangari, Gopal; Kane, Ari J.; McDermott, Michael W.; Berger, Mitchel S.; Parsa, Andrew T.

doi:10.3171/2010.5.jns091972

Cited by 75 publications

(43 citation statements)

References 32 publications

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“…In addition, in a 2010 single center teaching hospital in Alberta, Lwu et al found the rate of seizure prophylaxis to be 27% [15] . Deviation from the guideline recommendations may be attributed to the perceived harms of seizures on the patients' psychosocial and physical well-being, especially during the immediate post-operative period where the risk of seizures is known to be higher [6,18,20] . Our center revealed a 28% prophylaxis rate overall, which is similar to the prophylaxis rate found by Lwu and colleagues in Alberta.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the incidence and severity of AED related side effects were noted to be higher in brain tumour patients compared to a general population of patients receiving AEDs [7] . Subsequent metaanalyses and systematic reviews conducted after the release of these guidelines further support this recommendation [5,12,13,18,19] . One of the major limitations in interpreting the available evidence is that many patients who experienced seizures while receiving AED prophylaxis had sub-therapeutic levels.…”

Section: Analysis Of the Adherence To Seizure Prophylaxis Guidelines mentioning

confidence: 91%

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Analysis of the Adherence to Seizure Prophylaxis Guidelines in Neurosurgery Patients

Liao

Chiu

et al. 2016

International Journal of Neurology Research

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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 ...

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Section: Discussionmentioning

confidence: 99%

Section: Analysis Of the Adherence To Seizure Prophylaxis Guidelines mentioning

confidence: 91%

Analysis of the Adherence to Seizure Prophylaxis Guidelines in Neurosurgery Patients

Liao

Chiu

et al. 2016

International Journal of Neurology Research

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“…In a study of 121 patients undergoing glioma surgery, despite consistent perioperative AED prophylaxis, 9.1% of patients experienced a seizure within the first postoperative week, and problems with drug tolerability were not uncommon . In another observational series on meningioma surgery without seizure history, there was one single postoperative seizure in the group of 51 patients on AED prophylaxis and no seizures in 129 patients who did receive prophylaxis, suggesting little difference in seizure risk (Sughrue et al, 2011). Therefore, while AED prophylaxis remains commonly prescribed in patients with brain tumors (Siomin et al, 2005;Riva et al, 2006;Rosati et al, 2009;Lwu et al, 2010), the majority of evidence and clinical guidelines advise against this practice, and the application of perioperative prophylaxis will require further investigation.…”

Section: Prophylactic Aed Usementioning

confidence: 99%

Epilepsy and Brain Tumors

Newton

Maschio²,

Pritikin³

2015

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Seizures are common in patients with brain tumors, and epilepsy can significantly impact patient quality of life. Therefore, a thorough understanding of rates and predictors of seizures, and the likelihood of seizure freedom after resection, is critical in the treatment of brain tumors. Among all tumor types, seizures are most common with glioneuronal tumors (70-80%), particularly in patients with frontotemporal or insular lesions. Seizures are also common in individuals with glioma, with the highest rates of epilepsy (60-75%) observed in patients with low-grade gliomas located in superficial cortical or insular regions. Approximately 20-50% of patients with meningioma and 20-35% of those with brain metastases also suffer from seizures. After tumor resection, approximately 60-90% are rendered seizure-free, with most favorable seizure outcomes seen in individuals with glioneuronal tumors. Gross total resection, earlier surgical therapy, and a lack of generalized seizures are common predictors of a favorable seizure outcome. With regard to anticonvulsant medication selection, evidence-based guidelines for the treatment of focal epilepsy should be followed, and individual patient factors should also be considered, including patient age, sex, organ dysfunction, comorbidity, or cotherapy. As concomitant chemotherapy commonly forms an essential part of glioma treatment, enzyme-inducing anticonvulsants should be avoided when possible. Seizure freedom is the ultimate goal in the treatment of brain tumor patients with epilepsy, given the adverse effects of seizures on quality of life.

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“…While it is universally recognized that preoperative seizures must be controlled with AED administration, 25 significant controversy surrounds the use of perioperative AED prophylaxis for patients undergoing brain tumor resection with no seizure history. 58 A prophylactic drug should only be given if the risk of the adverse outcome (i.e., a seizure) is prominent and the medication is both effective at preventing it and poses an acceptable risk of toxicity. 25 The American Academy of Neurology released practice parameters in 2000 advising against AED prophylaxis in newly diagnosed brain tumor patients due to a lack of efficacy and heightened adverse effects in their meta-analysis.…”

confidence: 99%

“…15 While historical series demonstrated effective seizure prevention using AEDs following craniotomy, 42,43 recent data suggest a low baseline incidence of postoperative seizures even in the absence of AED prophylaxis. 26,58 The purpose of this study was to critically analyze the literature to select the current best available evidence. Personal preference heavily influences decision making on AED use following brain tumor surgery, 58 perhaps an indication that the literature has not been translated into treatment recommendations for clinical practice.…”

confidence: 99%

Anticonvulsant prophylaxis for brain tumor surgery: determining the current best available evidence

Sayegh

Fakurnejad²,

Oh³

et al. 2014

JNS

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Patients who undergo craniotomy for brain tumor resection are prone to experiencing seizures, which can have debilitating medical, neurological, and psychosocial effects. A controversial issue in neurosurgery is the common practice of administering perioperative anticonvulsant prophylaxis to these patients despite a paucity of supporting data in the literature. The foreseeable benefits of this strategy must be balanced against potential adverse effects and interactions with critical medications such as chemotherapeutic agents and corticosteroids. Multiple disparate metaanalyses have been published on this topic but have not been applied into clinical practice, and, instead, personal preference frequently determines practice patterns in this area of management. Therefore, to select the current best available evidence to guide clinical decision making, the literature was evaluated to identify meta-analyses that investigated the efficacy and/or safety of anticonvulsant prophylaxis in this patient population. Six meta-analyses published between 1996 and 2011 were included in the present study. The Quality of Reporting of Meta-analyses and Oxman-Guyatt methodological quality assessment tools were used to score these meta-analyses, and the Jadad decision algorithm was applied to determine the highest-quality meta-analysis. According to this analysis, 2 metaanalyses were deemed to be the current best available evidence, both of which conclude that prophylactic treatment does not improve seizure control in these patients. Therefore, this management strategy should not be routinely used.

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Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated?

Cited by 75 publications

References 32 publications

Analysis of the Adherence to Seizure Prophylaxis Guidelines in Neurosurgery Patients

Analysis of the Adherence to Seizure Prophylaxis Guidelines in Neurosurgery Patients

Epilepsy and Brain Tumors

Anticonvulsant prophylaxis for brain tumor surgery: determining the current best available evidence

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