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.

Phenobarbital (PB) was tested for its efficacy in averting post-traumatic epilepsy (PTE) in patients with non-missile head injuries. The protocol envisaged the administration of PB throughout a period of two years in randomly assigned doses ranging from 0.5 to 1.5 and from 1.6 to 2.5 mg/kg/day. The study included neurologic examination, EEG and plasma PB levels. Ninety patients, 83 of whom with serious head injury, followed the prescribed treatment for the entire period. Two adult patients manifested seizures 5 and 10 months afier the trauma. They were being treated with doses over 1.5 mg/kg/day. Another patient had a seizure six months after the end of the prophylaxis. Low doses of PB and monitoring permitted a reduction of side effects. The low incidence of PTE indicates that PB has an efficient prophylactic effect. The results also show that a low dosage has a favourable effect.

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Purpose: Vagus Nerve Stimulation (VNS) is indicated in the treatment of pharmacoresistant epilepsy. Albeit its general efficacy, the use of VNS remains undefined concerning two points: i) there are only a few long-term studies, none randomized; ii) there are no clinical markers which allow to predict VNS response. In order to explore these points, we report the long-term outcomes of VNS in 22 patients.Methods: Twenty-two patients with refractory epilepsy, either symptomatic generalized or cryptogenic/symptomatic partial were treated with VNS and monitored up to 15 years (6.5+1.1).Results: No significant adverse events were observed. VNS efficacy was enduring and increased significantly over time. Seizure frequency decreased by 34.3+3.9% after 1 year, 40.3+4.6% after 2 years, 48.0+5.4% after 3 years, 53.4+7.9% after 5 years and 48.1%+5.8 at maximum follow up. Data on syndrome-specificity were not significant (small number of patients in each group).Conclusions: This study confirms sustained efficacy of VNS in epilepsy. Generalized symptomatic and temporal lobe epilepsy seem to be associated to a better outcome to VNS, but additional data are required.