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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

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Comparison of the incidence of seizures after craniotomy in patients receiving prophylactic levetiracetam versus phenytoin

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  • Katharina Kern - Department of Neurosurgery, University of Regensburg, Germany
  • Karl-Michael Schebesch - Department of Neurosurgery, University of Regensburg, Germany
  • Jürgen Schlaier - Department of Neurosurgery, University of Regensburg, Germany
  • Alexander T. Brawanski - Department of Neurosurgery, University of Regensburg, Germany
  • Max Lange - Department of Neurosurgery, University of Regensburg, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1557

doi: 10.3205/10dgnc034, urn:nbn:de:0183-10dgnc0344

Published: September 16, 2010

© 2010 Kern et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: North et al. reported a natural risk for post-craniotomy seizures of 16.7% in the placebo-treated control group and a 7.9% risk in the prophylactically phenytoin-treated verum group. Therefore antiepileptic drugs are routinely given for craniotomies in many neurosurgical centres. Phenytoin is the most commonly used agent, but it can provoke serious side effects especially concerning cardiac events. Therefore, newer antiepileptic drugs like levetiracetam have been recommended for this indication. This study compares the incidence of seizures in patients receiving either prophylactic levetiracetam or phenytoin perioperatively.

Methods: During a two-year-period, patients undergoing a craniotomy were analysed retrospectively. All patients suffered from intracranial neoplasms. For perioperative prophylaxis, levetiracetam (in patients with contraindications for phenytoin) or phenytoin was used. Seizures were counted as documented in the patients’ charts during the first seven days after craniotomy.

Results: Data of 237 patients with perioperative seizure prophylaxis could be evaluated. 45% were female, 55% male. 81 patients (34%) received levetiracetam, 154 patients (65%) phenytoin as a prophylactic medication. 2 patients (1%) were treated with both drugs. 9 patients (4%) experienced a seizure despite this regimen. Seizures occurred in 2/81 patients (2,5%) who received levetiracetam versus 7/154 patients (4.5%) who received phenytoin. None of the 237 patients had side effects or drug interactions.

Conclusions: The data show that levetiracetam seems to be a valid option concerning the perioperative prophylactic anticonvulsive medication compared to phenytoin in patients who undergo craniotomy. As only 4% experienced a seizure and no adverse events occurred, the results suggest that perioperative prophylactic medication is useful and safe. In order to compare the incidence of seizures in patients receiving either prophylactic levetiracetam or phenytoin, larger collectives must be analysed.