The incidence of postoperative epilepsy and prophylactic anticonvulsants in patients with intracranial aneurysm

The occurrence of epileptic seizures is not rare after craniotomy. The authors in the incidence of postoperative epilepsy in 150 patients with intracranial aneurysm. Anticonvulsants were given to all patients after operation, but in 12 cases anticonvulsants were discontinued because of liver dysfunction. One hundred and eight out of 138 cases (78%) were treated polypharmaceutically, and 30 (22%) monopharmaceutically. The daily dose of anticonvulsants was as follows: diphenylhydantion (DPH) was 150-300mg, phenobarbital (PB) was 50-100mg, valproic acid (VPA) was 600-1200mg, and carbamazepin (CBZ) was 200-600 mg. Postoperative epilepsy occurred in 14 of 150 cases (9.3%), 13 cases with anticonvulsants, and 1 case without anticonvulsants. The site of aneurysm was as follows: 6 cases (10.3%) of AC aneurysm, 3 cases (9.7%) of MC aneurysm, 1 case (2.4%) of IC aneurysm, and 4 cases (21.1%) of multiple aneurysm. The interval between operation and epileptic seizure was 2 to 57 months (mean 19.8 months); in 7 cases (50%) within 1 year, and in 13 cases (93%) within 3 years. The authors emphasize that prophylactic use of anticonvulsants is effective to control subclinical epileptic seizures and prescribe anticonvulsants to all patients after craniotomy in general. The medication of anticonvulsants for 3 years would be necessary for avoiding postoperative epileptic seizures.