Editorial: Anticonvulsant Prophylaxis in Neurosurgery

Jb, North

doi:10.3109/02688698909002827

Cited by 17 publications

(6 citation statements)

References 12 publications

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“…North et al 2 44 also stress the importance of achieving therapeutic anticonvulsant concentrations. In their trial, seven of the nine patients experiencing generalised convulsions had subtherapeutic drug concentrations.…”

Section: Discussionmentioning

confidence: 99%

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Comparative double blind clinical trial of phenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy: efficacy, tolerability, and cognitive effects

Beenen

Lindeboom

Trenité

et al. 1999

Journal of Neurology, Neurosurgery & Psychiatry

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Objective-To determine the eYcacy, tolerability, and impact on quality of life and cognitive functioning of anticonvulsant prophylaxis with phenytoin or sodium valproate in patients after craniotomy. Methods-A prospective, stratified, randomised, double blind single centre clinical trial was performed, comparing two groups of 50 patients each, who underwent craniotomy for diVerent pathological conditions and who were treated for 1 year after surgery with either 300 mg phenytoin/day or 1500 mg sodium valproate/day. During the study period patients were seen in the outpatient clinic at 1.5, 3, 6, and 12 months, when medical history, adverse events, and drug plasma concentrations were evaluated. Neuropsychological functioning and quality of life were assessed on the last three visits. In cases of a seizure an EEG was performed, drug plasma concentration assessed, and medication subsequently increased. Results-Of the 100 included patients 14 (seven in each group) experienced one or more postoperative seizures. Severity of the seizures was comparable in the two groups. In all patients, drug plasma concentrations were in the low or subtherapeutic ranges at the time of the first postoperative seizure. Five patients in the phenytoin group and two in the valproate group had to stop their treatment due to drug related adverse events. Sixty patients completed the 12 month period. Analysis of neuropsychological and quality of life data showed no significant diVerences. Conclusion-For eYcacy, tolerability, impact on cognitive functioning, and quality of life, no major diVerences were found between phenytoin and valproate prophylaxis. Valproate is an alternative for anticonvulsant prophylaxis in patients after craniotomy. (J Neurol Neurosurg Psychiatry 1999;67:474-480)

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Section: Discussionmentioning

confidence: 99%

“…2 The incidence of epilepsy primarily depends on the underlying pathology; the overall incidence is estimated to be 17% 3. Some neurosurgical diseases are related to a relatively high incidence of postoperative seizures—for example, cerebral abcess and head trauma with intracerebral haematoma 4-7.…”

mentioning

confidence: 99%

Comparative double blind clinical trial of phenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy: efficacy, tolerability, and cognitive effects

Beenen

Lindeboom

Trenité

et al. 1999

Journal of Neurology, Neurosurgery & Psychiatry

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“…For example, PHT exposure in animal models of ischemic stroke leads to worse recovery (4,5). Furthermore, PHT often causes fever, which is independently associated with worse outcome after neural injury (3,10,16,17). Finally, as noted, the "PHT burden" may be correlated with worsening cognitive deficit (15).…”

Section: Short-term Phenytoin Prophylaxis and Subarachnoid Hemorrhagementioning

confidence: 92%

Three-Day Phenytoin Prophylaxis Is Adequate After Subarachnoid Hemorrhage

2007

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“…There is limited evidence of a prophylactic or antiepileptogenic benefit. 1,11,13,14 In addition, there have been other studies concluding that routine use of prophylactic AEDs is not helpful in decreasing seizure incidence. 3,9,[15][16][17] All previously studied drugs have well known adverse drug reactions (ADRs) that can also lead to serious complications.…”

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confidence: 95%