P12.11 Seizure prophylaxis in meningioma surgery - is it time for a randomized controlled trial?

Abstract

Abstract Introduction: Seizures affect up to 50% of patients with meningioma. Anti-epileptic drugs (AEDs) cause adverse effects in ~20% of patients. Guidelines recommend against routine use of prophylactic AEDs. The aim of this study was to evaluate the use of AEDs in meningioma surgery in the UK. Materials and methods: Email survey of UK neurosurgeons to ascertain: (i) use of prophylactic AED; (ii) preferred AED, dose and duration of use; (iii) tumour location and radiological factors that influence use of AED; (iv) willingness to participate in a future randomised controlled trial. Results: 60 completed surveys from 25 neurosurgical centres. Use of prophylactic AED was ‘almost never’ in 37/61 (61%); ‘rarely’ 10/61 (16%); ‘often’ 8/61 (13%) and ‘almost always’ 6/61 (10%). 42 surgeons had prescribed AEDs at some point; Levitoracetam (n=23) and phenytoin (n=18) were the commonest. Duration of prescription ranged from single dose at surgery to 3 months. Commonest duration was 7 days (n=18) and 14 days (n=8). Sphenoid (24/49; 49%) and olfactory (17/49; 35%) location, oedema (26/49; 53%) and mass effect/midline shift (20/49; 41%) were factors associated with prophylactic AED use. 80% of surgeons would participate in a randomised controlled trial. Conclusions: Most UK neurosurgeons follow guidelines and do not routinely prescribe prophylactic AEDs. Sphenoid and olfactory meningiomas and those with oedema are more likely to receive prophylactic AEDs which suggests neurosurgeons are more concerned about the consequences of seizures in these patients. A randomised controlled trial is required to provide class I evidence of those patients that may benefit from prophylactic AEDs in meningioma surgery and a proposal will be presented.