Abstracts

Rationale: Prophylactic antiepileptic drugs (AEDs) reduce the risk of seizures after craniotomy for supratentorial brain tumors. There are no evidence-based guidelines for AED management in the perioperative period, and there is minimal information about the use of newer AEDs for seizure prophylaxis. This study was designed to determine the rates of perioperative seizures in patients undergoing craniotomy for the diagnosis or treatment of supratentorial tumors. The study was also intended to analyze the rates of adverse events associated with perioperative AED use and to characterize the current pattern of AED use in brain tumor patients undergoing craniotomy. Methods: A restrospective chart review of all patients admitted to the Hospital of the University of Pennsylvania from January 1, 2006 and April 4, 2007 for either biopsy or resection of intracranial tumors was performed (N=119). Information regarding patient demographics, tumor type and location, surgery, seizure type and frequency and AED use was collected and analyzed. Results: Data was collected on a total of 119 patients. All patients received AEDs during their hospital stay. A total of 7.5% of patients experienced perioperative seizures during the course of their hospital stay. Phenytoin and levetiracetam were the most commonly prescribed medications; 69% of patients received phenytoin during the perioperative period, 31% of patients received levetiracetam during the perioperative period and 11% of patients received another AED during the perioperative period. 50% of patients had been on an AED prior to their surgery; of these patients, 50% were continued on the same (preoperative) antiepileptic drug during the perioperative period. 13% of patients had an additional AED added during the perioperative period. There were no significant differences in seizure rates between the various AEDs. Perioperative adverse drug events requiring the discontinuation of an AED occurred in 1% of patients. Conclusions: Although phenytoin is the most commonly used perioperative AED, levetiracetam is being used increasingly for perioperative seizure management. The use of other AEDs is relatively rare. Many patients receive new or different AEDs during the perioperative period. Seizures and adverse events related to AEDs are rare during the perioperative period. Based on current practice patterns, there is clinical equipoise for a prospective trial of newer vs. older AEDs for perioperative seizure prophylaxis.