Postoperative Seizures: Epidemiology, Pathology, and Prophylaxis

Manaka, Shinya; Ishijima, Buichi; Mayanagi, Yoshiaki

doi:10.2176/nmc.43.589

Cited by 85 publications

(56 citation statements)

References 66 publications

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“…Pre-operative seizures attained 1/3 of study population and was comparable to frequency reported in other studies (2,12,16), while this study cohort had more early seizures than previous reports (11,12). Early seizures represent a well known risk factor for postsurgical epilepsy, as they correlate with the severity of the cerebral insult (14,20). In our study cohort incidence of late seizures (46% of study population) was quite elevated, occurring either in patients who had never experienced seizures before surgery and in subjects with pre-operative and early seizures.…”

Section: Discussionmentioning

confidence: 70%

“…cerebral oedema, local inflammation, excitotoxic damage, oxidative stress, impairment of neuron metabolism) (5). Late postoperative seizures represent actual epilepsy and occur when acute symptomatic events are excluded (14). Onset of postoperative epilepsy has been widely investigated and several risk factors for late seizures have been described (e.g.…”

mentioning

confidence: 99%

“…Onset of postoperative epilepsy has been widely investigated and several risk factors for late seizures have been described (e.g. primary disease, severity of surgical insult, pre-operative heraldic seizures occurrence) (14). Both early and late seizures negatively affect neurological outcome and patients' quality of life.…”

mentioning

confidence: 99%

“…Hence the possibility of postoperative seizure prophylaxis and therapy is more than desirable. The role of Anti Epileptic Drugs (AEDs) in risk reduction is debated (14,20). While antiepileptic treatment of seizures is mandatory, the advantage of prophylaxis with AEDs has not been clearly assessed.…”

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confidence: 99%

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Incidence and management of late postsurgical seizures in clinical practice.

Bartolini¹,

Lenzi²,

Vannozzi³

et al. 2012

Turkish Neurosurgery

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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.

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Section: Discussionmentioning

confidence: 70%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Incidence and management of late postsurgical seizures in clinical practice.

Bartolini¹,

Lenzi²,

Vannozzi³

et al. 2012

Turkish Neurosurgery

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“…Surgical insult to the brain seems to generate free radicals, which in turn leads to formation of epileptogenic focus. However, some recent studies have not supported the prophylactic efficacy of AEDs in most craniotomized patients, but further studies are required 18) . We excluded patients with endovascular coil embolization, hence the contribution of surgical insult as a risk factor for late epilepsy could not be compared with that of minimally invasive endovascular technique.…”

Section: Other Risk Factorsmentioning

confidence: 99%

Seizures and Epilepsy following Aneurysmal Subarachnoid Hemorrhage : Incidence and Risk Factors

Choi

et al. 2009

J Korean Neurosurg Soc

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Objective : Although prophylactic antiepileptic drug (AED) use in patients with aneurysmal subarachnoid hemorrhage (SAH) is a common practice, lack of uniform definitions and guidelines for seizures and AEDs rendered this prescription more habitual instead of evidence-based manner. We herein evaluated the incidence and predictive factors of seizure and complications about AED use. Methods : From July 1999 to June 2007, data of a total of 547 patients with aneurysmal SAH who underwent operative treatments were reviewed. For these, the incidence and risk factors of seizures and epilepsy were assessed, in addition to complications of AEDs. Results : Eighty-three patients (15.2%) had at least one seizure following SAH. Forty-three patients (7.9%) had onset seizures, 34 (6.2%) had perioperative seizures, and 17 (3.1%) had late epilepsy. Younger age (< 40 years), poor clinical grade, thick hemorrhage, acute hydrocephalus, and rebleeding were related to the occurrence of onset seizures. Cortical infarction and thick hemorrhage were independent risk factors for the occurrence of late epilepsy. Onset seizures were not predictive of late epilepsy. Moreover, adverse drug effects were identified in 128 patients (23.4%) with AEDs. Conclusion : Perioperative seizures are not significant predictors for late epilepsy. Instead, initial amount of SAH and surgery-induced cortical damage should be seriously considered as risk factors for late epilepsy. Because AEDs can not prevent early postoperative seizures (< 1 week) and potentially cause unexpected side effects, long-term use should be readjusted in high-risk patients.

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