[Postoperative convulsion on the long-term follow-up in aneurysmal surgery]

There is some controversy in the long-term use of anticonvulsants for all postoperative cases. In order to establish the appropriate use of anticonvulsants, postoperative convulsion was studied concerning its incidence, onset and relevance with site of aneurysm, focal neurological deficits, CT findings and anticonvulsants in 169 cases of aneurysmal surgery under surgical microscope in the period of 1 to 11 years postoperatively. Convulsion was noted in 26 cases among 169 cases, and convulsion more than 1 week after operation (late convulsion) was noted in 20 cases (11.8%). Onset of late convulsion was most common during 6 to 12 months after operation and in 90 percent of cases it was developed within 2 years. In 2 of 5 cases with convulsion within 1 week late convulsion developed. On the site of aneurysm, middle cerebral artery aneurysmal cases showed high occurrence (20.5%) without statistical significance. Focal neurological deficit was one of predisposing factors for late convulsion with statistical significance (29.8%). On CT, 8 of 9 studied cases of late convulsion showed focal low density area involving cortex, although this was also noted in the cases without convulsion. Occurrence of late convulsion was significantly low (6.5%) in the cases without anticonvulsants. This suggests that there is low risk of late convulsion in the cases of uneventful postoperative course, no focal neurological signs and no abnormal findings on CT, even without anticonvulsants. Late convulsion occurred in about one third of cases treated with anticonvulsants. This is probably due to high risk and poor control of anticonvulsants plasma levels in some cases.(ABSTRACT TRUNCATED AT 250 WORDS)