Batista Sávio, Bertani Raphael, Palavani Lucca B, de Barros Oliveira Leonardo, Borges Pedro, Koester Stefan W, Paiva Wellingson Silva
Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil.
Department of Neurosurgery, São Paulo University, Sao Paulo 05508-220, Brazil.
Diagnostics (Basel). 2023 Nov 9;13(22):3415. doi: 10.3390/diagnostics13223415.
Seizures in the early postoperative period may impair patient recovery and increase the risk of complications. The aim of this study is to determine whether there is any advantage in postoperative seizure prophylaxis following meningioma resection.
This systematic review was conducted in accordance with PRISMA guidelines. PUBMED, Web of Science, Embase, Science Direct, and Cochrane were searched for papers until April 2023.
Among nine studies, a total of 3249 patients were evaluated, of which 984 patients received antiepileptic drugs (AEDs). No significant difference was observed in the frequency of seizure events between patients who were treated with antiepileptic drugs (AEDs) and those who were not. (RR 1.22, 95% CI 0.66 to 2.40; I = 57%). Postoperative seizures occurred in 5% (95% CI: 1% to 9%) within the early time period (<7 days), and 9% (95% CI: 1% to 17%) in the late time period (>7 days), with significant heterogeneity between the studies (I = 91% and 97%, respectively). In seizure-naive patients, the rate of postoperative seizures was 2% (95% CI: 0% to 6%) in the early period and increased to 6% (95% CI: 0% to 15%) in the late period. High heterogeneity led to the use of random-effects models in all analyses.
The current evidence does not provide sufficient support for the effectiveness of prophylactic AED medications in preventing postoperative seizures in patients undergoing meningioma resection. This underscores the importance of considering diagnostic criteria and conducting individual patient analysis to guide clinical decision-making in this context.
术后早期癫痫发作可能会妨碍患者康复并增加并发症风险。本研究的目的是确定脑膜瘤切除术后进行癫痫预防是否有任何益处。
本系统评价按照PRISMA指南进行。检索了PUBMED、科学网、Embase、Science Direct和Cochrane数据库，直至2023年4月。
在9项研究中，共评估了3249例患者，其中984例患者接受了抗癫痫药物（AEDs）治疗。接受抗癫痫药物（AEDs）治疗的患者与未接受治疗的患者在癫痫发作事件频率上未观察到显著差异。（风险比1.22，95%置信区间0.66至2.40；I² = 57%）。术后早期（<7天）癫痫发作发生率为5%（95%置信区间：1%至9%），晚期（>7天）为9%（95%置信区间：1%至17%），各研究之间存在显著异质性（分别为I² = 91%和97%）。在无癫痫病史的患者中，早期术后癫痫发作率为2%（95%置信区间：0%至6%），晚期增至6%（95%置信区间：0%至15%）。高度异质性导致在所有分析中使用随机效应模型。
目前的证据不足以支持预防性使用AED药物对接受脑膜瘤切除术患者预防术后癫痫发作的有效性。这凸显了在这种情况下考虑诊断标准并进行个体患者分析以指导临床决策的重要性。
