Optimizing therapy of seizures in neurosurgery.
The use of antiepileptic drugs (AEDs) in the neurosurgical setting has a number of implications, including their possible role in the prevention of seizures after acute cerebral insults or brain tumors and the potential for toxicity and interactions when these agents are administered in association with radiotherapy or chemotherapy. This review discusses these controversial issues and draws the following conclusions. 1) AEDs should be prescribed on a short-term basis to prevent seizures occurring within the first week after a cerebral insult (trauma, neurosurgical procedure) but are ineffective to avoid true post-traumatic epilepsy or first seizures in patients with primary or secondary cerebral neoplasms. 2) The use of phenytoin and, to a lesser extent, phenobarbital and carbamazepine during cranial irradiation is associated with an increased risk for severe, potentially fatal, mucocutaneous reactions. In this context, new AEDs with a very low potential for allergic cutaneous reactions should be preferred. 3) Enzyme-inducing AEDs, such as phenytoin, phenobarbital, and carbamazepine, may increase the clearance and reduce the clinical efficacy of corticosteroids and anticancer agents that are also metabolized by the cytochrome P450 system. The newly developed AEDs that are devoid of hepatic metabolism, such as levetiracetam and gabapentin, are now recommended because of good results in preliminary studies and because they do not show interactions with anticancer agents.
Michelucci
Roberto
R
Department of Neurosciences, Bellaria Hospital, Bologna, Italy. roberto.michelucci@ausl.bo.it
D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy; D002531:Cerebellum / Q000601:surgery; D006259:Craniocerebral Trauma / Q000150:complications; D004347:Drug Interactions; D004827:Epilepsy / Q000188:drug therapy* / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011832:Radiation Injuries
D000927:Anticonvulsants; D000970:Antineoplastic Agents