Prophylactic levetiracetam for seizure control after cranioplasty: a multicenter prospective controlled study

• Published in: World neurosurgery Vol. 102; pp. 284 - 292
• Main Authors: Liang, Shuli, Ding, Ping, Zhang, Shaohui, Zhang, Junchen, Zhang, Jiwu, Wu, Yuping
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017
• Subjects: Adult; Anticonvulsants - therapeutic use; Cranioplasty; Craniotomy - adverse effects; Electroencephalography; Female; Humans; Intracranial Hypertension - surgery; Kaplan-Meier Estimate; Levetiracetam; Magnetic Resonance Imaging; Male; Middle Aged; Neuropsychological Tests; Neurosurgery; Piracetam - analogs & derivatives; Piracetam - therapeutic use; Postoperative seizure; Prophylaxis; Prospective Studies; Retrospective Studies; Seizures - diagnostic imaging; Seizures - prevention & control; Surgery, Plastic - adverse effects; Tomography Scanners, X-Ray Computed; anti-epilepsy drugs; electroencephalograph; magnetic resonance imaging; MQ; MRI; cranioplasty; EEG; ADL-BI; IQ; prophylaxis; AEDs; CT; activities of daily living Barthel index; postoperative seizure; LEV; intelligence quotient; memory quotient; levetiracetam; computer tomography; AED; OR; BI ADL; CI; Prophylaxis; ADL; Cranioplasty; 3D; Postoperative seizure; Levetiracetam
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.03.020

Abstract Purpose To study the efficacy and safety of prophylactic levetiracetam (LEV) administration in adults undergoing cranioplasty. Methods Two hundred adults undergoing cranioplasty were prospectively enrolled and randomly divided into LEV group (prophylactic LEV for 24 weeks) and control group (no prophylactic anti-epileptic drugs). The patients’ demographic and clinical characteristics, occurrence of postoperative seizure, changes in intelligence quotient (IQ), memory quotient (MQ), and activities of daily living (ADL) scores, as well as postoperative hospital stay side effects, were all analyzed at 2-, 24-, and 48-week follow-up visits. Results Significant differences were found between the groups in both early-stage seizures in the initial 2 weeks and late-stage seizures in the 3-24 weeks after cranioplasty (p<0.05). The occurrences of postoperative seizures were 17.0% in the control and 4.1% in the LEV groups 48 weeks after cranioplasty, which was found to be significant (p=0.0020). The patients with abnormal pre- or postoperative EEG with spikes or sharp waves presented with an increased number of postoperative seizure attacks compared to those with normal EEG readings at 48 weeks. Significant differences were found between patients with postoperative seizure and those without postoperative seizures in regards to in changes in IQ, MQ, ADL, and patient satisfaction scores (p<0.01). No significant difference was found in side effects between the two groups. Conclusions Postoperative seizure was a common complication of cranioplasty, especially in those presenting pre- or postoperative abnormal EEG with spikes or sharp waves. Prophylactic LEV administration significantly reduced post-cranioplasty seizures during LEV usage and presented few side effects.