Prophylactic anticonvulsants for prevention of immediate and early postcraniotomy seizures

Shih Tseng Lee*, Tai Ngar Lui, Chen Nen Chang, Wan Chun Cheng, Dah Jium Wang, Robert F. Heimburger, Chii Guang Lin

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

85 Scopus citations

Abstract

Phenytoin (15 mg/kg) was administered intravenously to 189 patients shortly before their intracranial, supratentorial surgery was completed. Intravenous phenytoin of 5-6 mg/kg/day in three divided doses was administered daily for the first 3 postoperative days. Therapeutic serum levels (10-20 μg/mL) were achieved in 113 (59.8%) patients. An equally constituted, randomized control group of 185 patients received a placebo under identical conditions. The group receiving phenytoin had only one immediate and two early postoperative seizures. The 185 controls had four immediate and nine early postoperative seizures. None of the follow-up computed tomography scans of the patients with seizures showed postoperative hematoma. One patient had a significant tension pneumocranium, a possible cause of postoperative seizures. To avoid a decrease in the serum anticonvulsant level due to intraoperative blood loss, it is suggested that for patients who need an urgent or emergent craniotomy, prophylatic anticonvulsant medication should be given at least 20 minutes before completion of wound closure.

Original languageEnglish
Pages (from-to)361-364
Number of pages4
JournalSurgical Neurology
Volume31
Issue number5
DOIs
StatePublished - 05 1989

Keywords

  • Anticonvulsant medication
  • Craniotomy
  • Intracranial surgery
  • Phenytoin
  • Postoperative seizures

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