Bartolini Emanuele, Lenzi Bruno, Vannozzi Riccardo, Parenti Giuliano Francesco, Iudice Alfonso
University of Pisa, Department of Neuroscience, Pisa, Italy.
Turk Neurosurg. 2012;22(5):651-5. doi: 10.5137/1019-5149.JTN.6084-12.0.
Seizures are a frequent complication in patients who undergo neurosurgery, and can complicate the post-operative course and deteriorate patients' quality of life. Evidence on the prophylactic anticonvulsant therapy after craniotomy is still lacking.
We undertook an observational longitudinal study following neurosurgical supratentorial interventions, to evaluate seizures onset or persistence, and differences in effectiveness between conventional and newer AEDs.
A total of 100 consecutive subjects were enrolled. Each patient underwent a neurosurgical treatment by craniotomy. Pre-operative seizures occurred in 33% patients, early seizures in 13%. Late seizures occurred in 46 patients. At baseline (1 month after surgery) and during follow up the main therapeutic regimen was monotherapy. At last follow up adjustment of antiepileptic regimen or AED dosage had rendered 27 subjects seizure free. People taking newer AEDs at baseline maintain the same antiepileptic regimen more often than patients taking conventional AEDs; late seizures tended to have a higher incidence in the latter group. Adverse events from baseline AEDs were reported by 17% of patients.
In this study population late postsurgical seizures had a remarkable occurrence. Newer AEDs were continued more often than conventional AEDs, with a better tolerability but no significant differences in late seizures incidence.
癫痫发作是神经外科手术患者常见的并发症，可使术后病程复杂化并降低患者生活质量。目前仍缺乏关于开颅术后预防性抗惊厥治疗的证据。
我们对幕上神经外科手术干预后的患者进行了一项观察性纵向研究，以评估癫痫发作的起始或持续情况，以及传统抗癫痫药物（AEDs）与新型AEDs在疗效上的差异。
共纳入100例连续患者。每位患者均接受了开颅神经外科治疗。33%的患者术前有癫痫发作，13%有早期癫痫发作。46例患者出现晚期癫痫发作。在基线期（术后1个月）及随访期间，主要治疗方案为单药治疗。在最后一次随访时，调整抗癫痫治疗方案或AED剂量后，27例患者无癫痫发作。与服用传统AEDs的患者相比，基线期服用新型AEDs的患者更常维持相同的抗癫痫治疗方案；后一组晚期癫痫发作的发生率往往更高。17%的患者报告了基线AEDs的不良事件。
在本研究人群中，术后晚期癫痫发作发生率较高。与传统AEDs相比，新型AEDs更常持续使用，耐受性更好，但晚期癫痫发作发生率无显著差异。
