Medical management for neurosurgical related seizures

ABSTRACT

Introduction: Seizures or chronic epilepsy are a relatively common occurrence in a neurosurgical setting. However, seizure treatment after neurosurgery has received less attention compared with other causes and only few data are availaible in the literature on management in neurosurgical patients.

Areas covered: This paper reviews the availaible data on the risk of seizures in patients undergoing neurosurgery and discusses the role of antiseizure therapy in the management of the postoperative period. Finally, some controversial issues on this topic are addressed.

Expert opinion: Despite the studies so far published on this topic, there are still no guidelines for the clinical practice. International recommendations do not generally support the use of antiseizure drugs in postsurgical patients. Nevertheless, their use still remains wide in the routine practice. Initiation of a treatment should be considered when the risk for prolonged seizures or chronic epilepsy is high and the risk of toxicity is acceptable. First generation antiseizures drugs seem to be quite effective although new drugs are associated with lower adverse effects risk and better tolerability.

KEYWORDS:

• Treatment
• neurosurgical related seizures
• seizures
• antiseizure drugs
• craniotomy

Article highlights

• Seizures are common occurrence in the postoperative period of neurosurgical patients.

• Neurosurgeon have to manage medical therapy of neurosurgical related seizures.

• There is a lack of contemporary literature in relation to management of seizure/epilepsy in the neurosurgical patient.

• Several studies have tried to determine whether prophylactic antiepileptic drugs would alter the natural history of post neurosurgical period, but controversial evidence have been reported.

• Guidelines consider anticonvulsivant prophylaxis to be an option for the first week after surgery but that the routine use of prophylactic anticonvulsants after the first week is not warranted

• Second generation antiepileptic drugs, especially Levetiracetam, seem to be as effective but less associated to adverse events than the first generation antiepileptic drugs.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Additional information

Funding

This paper was not funded.