Patterns of seizure prophylaxis after oncologic neurosurgery

Area of Science:

• Neurosurgery
• Neurology
• Oncology

Background:

• Limited evidence supports routine postoperative antiepileptic drug (AED) prophylaxis after oncologic neurosurgery.
• Current practice patterns for AED prophylaxis are largely unknown.

Purpose of the Study:

• To describe patterns and predictors of postoperative AED prophylaxis following intracranial tumor surgery.

Main Methods:

• Analysis of pharmacy claims and clinical data from the MarketScan Database over a 5-year period.
• Involved a national sample of 5895 patients undergoing intracranial tumor surgery.

Main Results:

• Levetiracetam (78.5%) and phenytoin (20.5%) were the most common AEDs for prophylaxis.
• Prophylaxis use varied significantly by tumor location, type, and surgical approach.
• Biopsies and infratentorial/transsphenoidal procedures were less likely to receive prophylaxis.

Conclusions:

• Seizure prophylaxis use after intracranial biopsies and supratentorial resections is highly variable, indicating a lack of consensus.
• Practice patterns may be influenced by geographic factors, post-discharge services, and prescribing defaults, rather than evidence.
• Well-powered trials are necessary to determine the effectiveness, indications, and duration of AED prophylaxis.