Use of Prophylactic Anticonvulsants in Neurologic Critical Care: A Critical Appraisal

Liu, Kenneth C.; Bhardwaj, Anish

doi:10.1007/s12028-007-0061-5

Cited by 21 publications

(12 citation statements)

References 79 publications

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“…First generation AEDs can control early seizures but seem not to reduce incidence of late seizures. Studies with newer AEDs are scarce, but interest is rapidly increasing (13,16,22). The American Academy of Neurology recommends not to treat subjects with cerebral neoplasms and traumatic brain injury who have not had seizures beyond 1 week postoperatively or postinjury (4).…”

Section: Bartolini E Et Al: An Observational Longitudinal Study In Nmentioning

confidence: 99%

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: Bartolini E Et Al: An Observational Longitudinal Study In Nmentioning

confidence: 99%

Incidence and management of late postsurgical seizures in clinical practice.

Bartolini¹,

Lenzi²,

Vannozzi³

et al. 2012

Turkish Neurosurgery

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“…[4] The potential for seizures to exacerbate delayed cerebral ischemia may influence the duration of seizure prophylaxis after SAH. Many have argued for a shorter course of AEDs after SAH, given the association between their use and worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Cerebral infarction following a seizure in a patient with subarachnoid hemorrhage complicated by delayed cerebral ischemia

Sampson

Dhar²,

Zipfel³

2011

Surg Neurol Int

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Background:Seizures are a recognized complication of subarachnoid hemorrhage (SAH). They can increase the cerebral metabolic demands and lead to cardiopulmonary compromise. This could be detrimental in the setting of delayed cerebral ischemia (DCI), when the brain tissue is vulnerable to further reductions in oxygen delivery or increases in demand. An association between seizures and worsening ischemia could influence the decision to use antiepileptic drug (AED) prophylaxis in patients with vasospasm.Case Description:A 64-year-old woman developed confusion, aphasia and right hemiparesis on day 7 after aneurysmal SAH. Angiography confirmed severe anterior circulation vasospasm. She initially responded to hypertensive therapy with almost complete resolution of her ischemic neurological deficits. However, on day 10, she had a single generalized seizure and required intubation for airway protection. Her blood pressure dropped with AED initiation, necessitating an increase in the previously stable dose of vasopressors. She developed aphasia and worsening hemiparesis that did not resolve despite hemodynamic augmentation. Subsequent head computed tomographies revealed new infarction in the left anterior cerebral artery territory not present previously. She had received prophylactic phenytoin for only 3 days, as per our SAH protocol.Conclusion:AED prophylaxis is typically used early after SAH when the risk is high and a seizure may precipitate aneurysmal rebleeding. This case illustrates how a later seizure in the setting of vasospasm can lead to decompensation of DCI, with potential for irreversible infarction. Therefore, patients with vasospasm may benefit from extended durations of prophylaxis to prevent such complications.

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“…[38] Following the general procedure II, 3t was obtained. Yield 176 mg (66 %) as a yellow oil; IR (KBr) /cm -1 : ν = 3285, 1608; 1 [39] A mixture of Imiquimod (240 mg, 1 mmol), palladium(II) acetate (24 mg, 0.1 mmol), sodium diphenylphosphinobenzene-3-sulfonate (TPPMS, 72 mg, 0.2 mmol) and benzyl alcohol (2) (515 μL, 5 mmol) in H 2 O (4 mL) was heated at 140°C for 18 h in a sealed tube under air. After cooling, the reaction mixture was poured into water and…”

Section: N-benzylisoquinolin-1-amine (3a)mentioning

confidence: 99%

“…For example, papaverine hydrochloride is a well-known opium alkaloid used as an antispasmodic drug. [1] Recently, 1-aminoisoquinoline derivatives [2] have been widely used as a PKA inhibitor, [3] JAK2 inhibitor, [4] adenosine A 3 receptor ligand (VUF8504), [5] topoisomerase I inhibitor, [6] and PDE5 inhibitor. [7] Therefore, efficient methods for the direct introduction of diverse functionalities on isoquinolines are gaining increasing interest in modern drug discovery.…”

Section: Introductionmentioning

confidence: 99%

A Borrowing Hydrogen Strategy for Dehydrative Coupling of Aminoisoquinolines with Benzyl Alcohols in Water

et al. 2019

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We report a borrowing hydrogen strategy for a palladium-catalyzed dehydrative coupling of aminoisoquinolines with benzylic alcohols in water. This cascade reaction using the π-benzylpalladium system can be achieved in an atom-economic process without the need for base or other additives, furnishing the N-benzylated aminoisoquinolines in moderate to excellent yields along with water as the sole co-product. The crossover experiment using [D 7 ]benzyl alcohol and 4-methoxybenzyl alcohol afforded H/D scrambled products. KIE experi- [a]

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Use of Prophylactic Anticonvulsants in Neurologic Critical Care: A Critical Appraisal

Cited by 21 publications

References 79 publications

Incidence and management of late postsurgical seizures in clinical practice.

Incidence and management of late postsurgical seizures in clinical practice.

Cerebral infarction following a seizure in a patient with subarachnoid hemorrhage complicated by delayed cerebral ischemia

A Borrowing Hydrogen Strategy for Dehydrative Coupling of Aminoisoquinolines with Benzyl Alcohols in Water

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