The efficacy of antiepileptic drug prophylaxis in the prevention of early and late seizures following repair of intracranial aneurysms

The efficacy of antiepileptic drug (AED) prophylaxis in patients undergoing aneurysm repair has been questioned, yet these drugs are routinely used in many institutions. To better define the relationship of AED prophylaxis to postoperative seizures, we undertook a review of 259 patients undergoing treatment for intracranial aneurysms. Incidence of late seizures was assessed by telephone interview in 132 patients (mean follow-up, 58.7 months). There were seven early seizures, all in patients who received AED prophylaxis (higher versus [vs.] no prophylaxis, p = 0.019). There were 12 late seizures (nine with prophylaxis vs. three without prophylaxis, p = 0.53). The timing of AED prophylaxis had no effect on the incidence of early or late seizures in either group. AED use was associated with an increased rate of early seizures. Postoperative seizures remain important adverse outcomes following aneurysm repair, but despite their traditional role, the routine use of AED should be reconsidered carefully.