Journal of the Korean Society of Stereotactic and Functional Neurosurgery 2015;11(1):1-4.
Published online June 30, 2015.
New-generation Anti-epileptic Drug (AED) Prophylaxis in Patients with Aneurysmal Subarachnoid Hemorrhage (SAH) Treated with Endovascular Coil Embolization
Sung-Baek Hue, Soon-Chan Kwon, Han-Yu Seong, Eun-Suk Park, Jun-Bum Park, Hong-Bo Sim, In-Uk Lyo
Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
The incidence and risk factor of seizures after aneurysmal subarachnoid hemorrhage (SAH), as well as the effect of anti-epileptic drug (AED) prophylaxis and the influence of the treatment modality for seizures, remain unclear. We conducted a prospective study using a new-generation AED to better understand the effect of AED prophylaxis on patients with SAH treated via endovascular coiling. Materials and Methods: We performed a prospective observational study of 77 serial patients managed with endovascular coil embolization after SAH between January 2012 and December 2013. We used AED [500mg Levetiracetam (LEV) twice a day] for one week in patients with Fisher Grades 2 and 3, and for four weeks in patients with Fisher Grade 4. The incidence of seizures was compared with published data, and potential factors related to seizures were evaluated.
Total 5 (6.5%) patients had any episode of seizures in this study. Medically controllable seizures, such as early and late seizures, were 2 (2.6%), 1 (1.3%) patients in each. The proposed predisposing factors of seizure incidence, such as age, the aneurysmal location, initial Fisher grade, Hunt-Hess grade, further surgical procedures after endovascular treatment, hydrocephalus, and symptomatic vasospasm were statistically insignificant, except for the re-bleeding (p=0.04).
The rate of seizure after SAH managed by coil embolization was so low compared to clipping group. Furthermore we think the short-term use of LEV for an SAH patient treated with endovascular coil embolization could controls early and late seizures.
Key Words: Seizures, Anti-epileptic drug (AED), Levetiracetam (LEV), Subarachnoid hemorrhage (SAH), Endovascular coil embolization.
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