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首页> 外文期刊>Open Journal of Modern Neurosurgery >Extended Antiepileptic Drug Prophylaxis and Late Onset Seizures in Aneurysmal Subarachnoid Hemorrhage
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Extended Antiepileptic Drug Prophylaxis and Late Onset Seizures in Aneurysmal Subarachnoid Hemorrhage

机译：扩展抗癫痫药物的预防和延迟发作在动脉瘤性蛛网膜下腔出血中的发作

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Background: The indication and optimal duration of antiepileptic drug (AED) prophylaxis after aneurysmal subarachnoid hemorrhage (SAH) remains controversial. Our institution practices routine seizure prophylaxis for variable durations at the discretion of the neurosurgeon and neuro-intensivist. Given the propensity of late onset seizures to progress to chronic epilepsy, we sought to investigate the efficacy of extended AED prophylaxis in reducing the risk of late seizures. Methods: This retrospective study analyzed 36 patients who were admitted to our neurosurgical intensive care unit (NICU) over a 2-year period (1st November 2015 to 31st October 2017). All hospital admissions records, electronic medication records as well as outpatient visits up to 1 year were reviewed. Late onset seizures were defined as seizures occurring more than 7 days post-intervention (or presentation if no intervention was performed) up to 1 year of follow-up. Results: Majority of the patients received Levetiracetam (94%) as seizure prophylaxis and late onset seizures occurred in 6 (17%) of the patients. Those patients who received a greater proportion of in-patient stay with AED prophylaxis had a statistically significant lower risk of developing late seizures (OR = 0.964, 95%, p = 0.02). Although the value tended towards benefit (OR = 0.382) for AED > 21 days in-hospital, the result was not statistically significant (p = 0.307). Conclusion: An extended duration of AED prophylaxis, in particular Levetiracetam, may confer some benefit in reducing risk of developing late seizures. However, the optimal duration of therapy is yet to be determined and further large multi-centered randomized studies are necessary.
机译：背景：动脉瘤性蛛网膜下腔出血（SAH）后抗癫痫药（AED）预防的适应症和最佳预防时间仍存在争议。根据神经外科医师和神经强化医师的判断，我们的机构在不同的时间进行常规的癫痫预防。鉴于迟发性癫痫发作有发展为慢性癫痫的倾向，我们寻求研究延长AED预防措施以降低迟发性癫痫发作风险的功效。方法：这项回顾性研究分析了在两年期间（2015年11月1日至2017年10月31日）接受神经外科重症监护病房（NICU）的36例患者。审查了所有住院记录，电子药物记录以及长达1年的门诊就诊记录。迟发性癫痫发作的定义为干预后7年内（或未进行干预的情况下出现）直至随访1年以上的癫痫发作。结果：大多数患者接受了左乙拉西坦（94％）预防癫痫发作，其中6例（17％）发生迟发性癫痫发作。那些接受较大比例的AED住院治疗的患者发生晚期癫痫的风险在统计学上显着较低（OR = 0.964，95％，p = 0.02）。尽管对于住院时间超过21天的AED，该值倾向于获益（OR = 0.382），但结果无统计学意义（p = 0.307）。结论：延长AED预防时间，尤其是左乙拉西坦，可能在降低晚期癫痫发作风险方面提供一些益处。然而，最佳治疗时间尚待确定，还需要进一步的大型多中心随机研究。

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