Postoperative seizures: epidemiology, pathology, and prophylaxis

Area of Science:

• Neurosurgery
• Epileptology
• Pharmacology

Background:

• Postoperative epilepsy risk after craniotomy is significant and variable.
• Neurosurgical insults may trigger seizures via free radical generation or ion imbalance.
• Efficacy of conventional antiepileptic drugs for preventing long-term postoperative epilepsy is debated.

Purpose of the Study:

• To evaluate the prophylactic effect of zonisamide against postoperative epilepsy in craniotomized patients.
• To investigate zonisamide's antiepileptogenic, free radical scavenging, and neuroprotective properties.

Main Methods:

• A randomized double-blind controlled trial was conducted.
• Patients undergoing craniotomy received prophylactic zonisamide treatment.
• Partial seizures were monitored during the follow-up period.

Main Results:

• Prophylactic zonisamide significantly prevented the development of partial seizures post-craniotomy.
• Zonisamide demonstrated antiepileptogenic and neuroprotective actions in experimental models.

Conclusions:

• Zonisamide shows promise for preventing partial seizures in craniotomized patients.
• Despite promising findings, recent studies cast doubt on prophylactic antiepileptic drug use, requiring further investigation.