[Risk and drug prevention of epileptic seizures after cerebral lesions]

As a basis for decisions a detailed report is given on the risk factors for seizures or epilepsy after acute brain lesions (trauma, surgery, vascular lesions). Regarding the prevention of seizures routine prophylactic treatment with antiepileptic drugs is not appropriate, since the benefits do not outweight the risks. The effects of antiepileptic drugs--as controlled studies with phenytoin and carbamazepine have shown--are limited to early seizures, and these drugs as well as phenobarbital do not influence the development of late posttraumatic epilepsy. With the exception of special cases in which a defined period of prophylactic treatment seems appropriate one may assume that competent pharmacological treatment in due time is probably more effective than early and questionable prophylaxis.