Levetiracetam seizure prophylaxis in craniotomy patients at high risk for postoperative seizures
Sankalp Gokhale1, Shariq Ali Khan2, Abhishek Agrawal3, Allan H Friedman4, David L McDonagh5
1 Department of Neurology, Division of Neurocritical Care, Duke University Medical Center, Durham, North Carolina 27710, USA
2 Department of Anesthesiology Division of Neuro Anesthesia, Duke University Medical Center, Durham, North Carolina 27710, USA
3 Division of Neurosurgery, Department of Surgery and Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA
4 Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
5 Department of Anesthesiology and Neurology, Division of Neuro Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA
Department of Neurology, Division of Neurocritical Care, Duke University School of Medicine, Durham, North Carolina 27710
Source of Support: None, Conflict of Interest: None
Background: The risk of developing immediate postoperative seizures in patients undergoing supratentorial brain tumor surgery without anti-epileptic drug (AED) prophylaxis is 15-20%. Patients who present with pre-operative seizures and patients with supratentorial meningioma or supratentorial low grade gliomas are at significantly higher risk. There is little data on the efficacy of levetiracetam as a prophylactic AED in the immediate postoperative period (within 7 days of surgery) in these patients.
Methods: We conducted a retrospective chart review of 165 adult patients classified as higher risk for postoperative seizures who underwent brain tumor resection at Duke University Hospital between time May 2010 and December 2011. All patients had received levetiracetam monotherapy in doses of 1000-3000 mg/day in the immediate postoperative period.
Results: We identified 165 patients with following tumor locations: Frontal 83 (50.3%), Temporal 37 (22.4%), Parietal 30 (18.2%), Occipital 2 (1.2%) and 13 (7.8%) with single lesions involving more than one lobe. Histology revealed: Glioma 98 (59.4%), Meningioma 57 (34.5%) and Brain Metastases 6 (3.6%). Preoperatively, 88/165 (53.3%) patients had presented with seizures. 12/165 patients (7.3%) developed clinical seizures (generalized 10, partial 2) in the immediate post-operative period. Other than somnolence in 7 patients (4.2%), no major side-effects were noted.
Conclusions: The incidence of seizures was significantly lower in patients treated with levetiracetam (7.3%) when compared with the expected (15-20%) rate without AED prophylaxis based on the previous literature. Levetiracetam appears effective and safe for seizure prevention in patients undergoing brain tumor resection and who are at significantly higher risk of developing post-operative seizures. These findings warrant confirmation in a prospective randomized trial.