Efficacy of postoperative seizure prophylaxis in intra-axial brain tumor resections

Shaheryar F Ansari,Bradley N Bohnstedt,James C Miller,Susan M Perkins,Sandra K Althouse

doi:10.1007/s11060-014-1402-9

Abstract

The effectiveness of seizure prophylaxis in controlling postoperative seizures following craniotomy for tumor resection is unclear. Most patients are seizure-free before surgery. To prevent seizures, it is common to treat tumor craniotomy patients postoperatively with an antiepileptic drug (AED). The authors retrospectively analyzed seizure occurrence with and without postoperative prophylactic AEDs. Between 2005 and 2011 at the authors’ institution, 588 patients underwent craniotomy for brain tumors and were screened. Data on seizures, AED use, histopathology, comorbidities, complications, and follow-up were collected. Exclusion criteria included lack of follow-up data, previous operation, preoperative seizures, or preoperative AED prophylaxis. The incidence of postoperative seizures in patients with and without prophylactic AEDs was compared using logistic regression analysis. A total of 202 patients (50.5 % female) were included. The most common tumor diagnosis was metastasis (42.6 %). Of the 202 patients, 66.3 % were prescribed prophylactic AED after surgery. Forty-six of 202 (22.8 %) suffered a postoperative seizure. The odds of seizure for patients on prophylactic AED was 1.62 times higher than those not on AED (p = 0.2867). No difference was found in seizure occurrence between patients with glioblastoma multiforme compared with other tumor types (odds ratio 1.75, p = 0.1468). No difference was found in time-to-seizure between the two groups (hazard ratio 1.38, p = 0.3776). These data show no statistically significant benefit to prophylactic postoperative AED and a nonsignificant trend for increased seizure risk with AEDs. A randomized, placebo-controlled trial is needed to clarify the benefit of postoperative AED use for brain tumor resection.

Highlights

Patients undergoing surgery for brain tumors have an estimated incidence of seizures ranging from 17 to 50 % [1,2,3,4,5,6]
Number (%) or Median postoperative seizures, only two patients in this series were found to have seizures within 30 days of surgery, and neither patient was on antiepileptic drug (AED) prophylaxis
In both logistic and time-to-event models, there was no interaction between prophylactic AED and Gliadel use on postoperative seizures, and the main effect for Gliadel use was not significant when the interaction term was removed from the models

Summary

Introduction

Patients undergoing surgery for brain tumors have an estimated incidence of seizures ranging from 17 to 50 % [1,2,3,4,5,6]. Studies that have investigated the question whether seizure prophylaxis benefits such patients have shown mixed results. The double-blinded, randomized controlled trial of North et al [7] found a significant reduction of postoperative seizures in a specific time period, other studies did not corroborate this finding [6, 8, 9]. A relatively recent retrospective review by Zachenhofer et al [5] found that patients given prophylactic levetiracetam may have a lower risk of seizure following craniotomy for tumor. Most of the studies published on postoperative seizure prophylaxis included heterogeneous populations—brain tumors, aneurysms, or trauma.

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Results

Conclusion