When Blood Tickles the Brain: Where Is the Argument?

Abstract

Listen

Translate article

here remains much controversy about the prevalence of seizures after aneurysmal subarachnoid hemorrhage T (ASAH), and the potential role of prophylactic anticonvulsants (PACs) in clinical practice in that setting. The arguments are beautifully summarized in the article by Raper et al. in this issue of WORLD NEUROSURGERY. Yet despite the absence of convincing proof about the efficacy of PACs in preventing early and late seizures, and plenty of concern about the side effects and potential lasting morbidity of PACs, surveys of current practice continue to document their routine use by a substantial fraction of neurosurgeons. As with most longstanding unsettled scientific controversies, this one has waned in recent years, and its arguments have tired. The reasons include the absence of data “settling the argument,” new practices that render the argument less relevant, and mostly that the argument has not been properly articulated. As one of those surgeons who has studied this problem, and who has not abandoned PACs after ASAH altogether, I am happy to explain why, in my opinion, this controversy has been overplayed, and the argument has often been misstated.