Analysis of the Adherence to Seizure Prophylaxis Guidelines in Neurosurgery Patients

Abstract

Background: In 2000, the American Academy of Neurology guidelines recommended that long-term seizure prophylaxis should not be routine in patients with newly diagnosed brain tumours and that if anti-epileptic drugs (AEDs) are used, they should be tapered and discontinued after 7 days post-operatively. Recent data shows that most newly diagnosed brain tumour patients continue to receive prophylactic AED. Aim: This study aimed to examine the seizure prophylaxis practices at Trillium Health Partners – Mississauga Hospital, a regional neurosurgery centrelocated in Mississauga, Ontario, Canada. Materials and Methods: A retrospective chart review was performed in adult patients with a newly diagnosed brain tumour who underwent neurosurgery between January 2010 and December 2014. Results: 690 patient charts were screened and 235 patients were excluded, most commonly due to seizure on admission. Overall, 28% (N=129) of 455 included patients over 5 years received seizure prophylaxis. Phenytoin was the most common prophylactic agent used. The average post-operative length of stay was 7.98 days and the average duration of therapy was 8.73 days. In 61% of patients who received prophylaxis, it was unknown whether the AED was continued in the long-term. The drug cost savings to Trillium over 5 years if patients had not received seizure prophylaxis was $4287.52. The patient characteristics most strongly correlated with receiving seizure prophylaxis were increasing tumour size and decreasing number of tumours. Conclusion: 1 in 3 patients at Trillium received seizure prophylaxis. Increased awareness of the organization's practice patterns may help prevent unnecessary long-term AED use.