Title:The Prophylactic Use of Antiepileptic Drugs in Patients Scheduled for Neurosurgery
VOLUME: 23 ISSUE: 42
Author(s):Barbara Miziak, Kinga Borowicz-Reutt, Radoslaw Rola, Barbara Blaszczyk, Miroslaw Czuczwar and Stanislaw J. Czuczwar*
Affiliation:Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Department of Neurological Surgery, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Faculty of Health Sciences, High School of Economics, Law and Medical Sciences, Jagiellońska 109A, 25-734 Kielce, 2nd Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081 Lublin, Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin
Keywords:Antiepileptic drugs, neurosurgery, craniotomy, traumatic brain injury, brain tumors, seizures.
Abstract:Antiepileptic drugs (AEDs) possess diverse mechanisms of action – enhancement of GABA-mediated
events, inhibition of glutamate-mediated excitation, blockade of voltage-dependent sodium or calcium channels
being the most frequently shared. They are not only used for the symptomatic management of epilepsy but in the
treatment of psychiatric or neurologic disorders (e.g. bipolar disorder, neuropathic pain, prophylaxis of migraine).
Generally, this group of drugs is also widely used in neurosurgery patients for the prevention of seizure activity
and their effectiveness in this regard has been evaluated in this review.
There is no controversy as to whether continue AEDs in patients with epilepsy scheduled for neurosurgery. A
question arises on whether AEDs may be recommended to non-epileptic neurosurgical patients for the prevention
of post-surgery early or late seizures. There are some positive examples indicating that AEDs may reduce the
occurrence of preferably early seizures, some results also being positive in the case of late seizure activity. However,
there are also many negative data in this regard. The existence of serious adverse effects and a possibility of
pharmacokinetic interactions with the concomitant therapy may further complicate the decision on whether to
start the prophylactic use of AEDs. In general, the existing evidence does not support the prophylactic use of
AEDs, especially in patients who underwent craniotomy/craniectomy for the inhibition of late seizure activity.
