Incidence and management of late postsurgical seizures in clinical practice.

Bartolini, Emanuele; Lenzi, B; Vannozzi, Riccardo; Parenti, G; Iudice, Alfonso

doi:10.5137/1019-5149.jtn.6084-12.0

Cited by 3 publications

(4 citation statements)

References 20 publications

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“…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.…”

Section: Discussioncontrasting

confidence: 39%

Postoperative Epileptic Seizures in Children

et al. 2022

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Background: Postoperative seizures (PS) occur in 10–15% of patients. This study aims to provide an update on the role of surgery in PS. Methods: All children undergoing a craniotomy for supratentorial lesions in the last 10 years were considered except those with preoperative seizures, perioperative antiepileptic drugs prophylaxis, head-injury and infections, repeated surgery, or preoperative hyponatremia. Children undergoing surgery for intra-axial lesions (Group 1, 74 cases) were compared with those harboring extra-axial lesions (Group 2, 91 cases). Results: PS occurred in 9% of 165 cases and epilepsy in 3% of 165 cases (mean follow-up: 5.7 years). There was no difference between the two study groups with regard to demographic data or tumor size. Group 1 showed a higher rate of gross total tumor resection (p = 0.002), while Group 2 had a higher rate of postoperative hyponatremia (p < 0.0001). There were no differences between the two groups in the occurrence of seizures (6.7% vs. 11%) or epilepsy (2.7% vs. 3.2%). No correlations were found between seizures and age, tumor location, histotype, tumor size, or the extent of tumor resection. Hyponatremia affected the risk of PS in Group 2 (p = 0.02). Conclusions: This study shows a lower rate of PS and epilepsy than series including children with preoperative seizures. Hyponatremia has a significant role. Neurosurgery is safe but surgical complications may cause late epilepsy.

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Section: Discussioncontrasting

confidence: 39%

Postoperative Epileptic Seizures in Children

et al. 2022

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“…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 .…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Pourzitaki

Tsaousi

Apostolidou

et al. 2016

Brit J Clinical Pharma

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AIMSThe aim of this study was to perform an up-to-date systematic review and meta-analysis on the efficacy and safety of prophylactic administration of levetiracetam in brain tumour patients. METHODA systematic review of studies published until April 2015 was conducted using Scopus/Elsevier, EMBASE and MEDLINE. The search was limited to articles reporting results from adult patients, suffering from brain tumour, undergoing supratentorial craniotomy for tumour resection or biopsy and administered levetiracetam in the perioperative period for seizure prophylaxis. Outcomes included the efficacy and safety of levetiracetam, as well as the tolerability of the specific regimen, defined by the discontinuation of the treatment due to side effects. RESULTSThe systematic review included 1148 patients from 12 studies comparing levetiracetam with no treatment, phenytoin and valproate, while only 243 patients from three studies, comparing levetiracetam vs phenytoin efficacy and safety, were included in the meta-analysis. The combined results from the meta-analysis showed that levetiracetam administration was followed by significantly fewer seizures than treatment with phenytoin (OR = 0.12 [0.03-0.42]: χ 2 = 1.76: I 2 = 0%). Analysis also showed significantly fewer side effects in patients receiving levetiracetam, compared to other groups (P < 0.05). The combined results showed fewer side effects in the levetiracetam group compared to the phenytoin group (OR = 0.65 [0.14-2.99]: χ 2 = 8.79: I 2 = 77%). CONCLUSIONSThe efficacy of prophylaxis with levetiracetam seems to be superior to that with phenytoin and valproate administration. Moreover, levetiracetam use demonstrates fewer side effects in brain tumour patients. Nevertheless, high risk of bias and moderate methodological quality must be taken into account when considering these results. British Journal of Clinical PharmacologyBr J Clin Pharmacol (2016) 82 315-325 315

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“…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.…”

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confidence: 99%

Seizure incidence in the acute postneurosurgical period diagnosed using continuous electroencephalography

Freund

Probasco

Ritzl

2019

Journal of Neurosurgery

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OBJECTIVEDelay in diagnosis and subsequent treatment of nonconvulsive seizures can lead to worsened outcomes. The gold standard in detecting nonconvulsive seizures is continuous video-electroencephalography (cEEG). Compared to routine, 30-minute EEG, the use of cEEG increases the likelihood of capturing intermittent nonconvulsive seizures. Studies of critically ill patients in intensive care units demonstrate a particularly high rate of nonconvulsive seizures. Some of these studies included postneurosurgical patients, but often subanalyses of specific populations were not done. In particular, few studies have specifically evaluated postneurosurgical patients by using cEEG in the acute postoperative setting. Therefore, the incidence and predictors of acute postneurosurgical seizures are unclear.METHODSIn this study, the authors focused on patients who were admitted to the neurological critical care unit following neurosurgery and who underwent cEEG monitoring within 72 hours of surgery.RESULTSA total of 105 cEEG studies were performed in 102 patients. Twenty-nine patients demonstrated electrographic (subclinical) seizures, of whom 10 had clinical seizures clearly documented either before or during cEEG monitoring. Twenty-two patients had subclinical seizures only detected on cEEG, 19 of whom did not have clinical seizure activity at any point during hospitalization. Those with seizures were more likely to have had a history of epilepsy (p = 0.006). The EEG studies of patients with seizures were more likely to show lateralized periodic discharges (p = 0.012) and lateralized rhythmic delta activity (p = 0.012). The underlying neuropathological disorders most associated with seizure risk were lobar tumor on presentation (p = 0.048), subdural hematoma (SDH) requiring craniotomy for evacuation (p = 0.002), subarachnoid hemorrhage (SAH) (p = 0.026), and perioperative SAH (p = 0.019). In those undergoing craniotomy, the presence of SDH (p = 0.032), particularly if requiring evacuation (p = 0.003), increased the risk of seizures. In those without preoperative intracranial bleeding, perioperative SAH after craniotomy was associated with a higher incidence of seizures (p = 0.014). There was an additive effect on seizure incidence when perioperative SAH as well as concomitant intraparenchymal hemorrhage and/or stroke were present. The clinical examination of the patient, including the presence or absence of altered mental status and the presence or absence of repetitive movements, was not predictive of subclinical seizures.CONCLUSIONSIn postneurosurgical patients referred for cEEG monitoring, there is a high rate of both clinical and subclinical seizures in the early postoperative period. Seizures are particularly common in patients with SDH or lobar tumor and perioperative SAH. There was an additive effect on seizure incidence when more extensive brain injury was present. As expected, those with a history of epilepsy also demonstrated higher seizure rates. Further studies are needed to evaluate the time period of maximum seizure incidence after surgery, and the effects acute postneurosurgical seizures have on long-term outcomes.

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Incidence and management of late postsurgical seizures in clinical practice.

Cited by 3 publications

References 20 publications

Postoperative Epileptic Seizures in Children

Postoperative Epileptic Seizures in Children

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

Seizure incidence in the acute postneurosurgical period diagnosed using continuous electroencephalography

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