Preoperative antiepileptic drug administration and the incidence of postoperative seizures following bur hole-treated chronic subdural hematoma.
OBJECTIVE
Despite the prevalence of chronic subdural hematoma (CSDHs) in the rapidly growing elderly population, several aspects of disease management remain unclear. In particular, there is still conflicting evidence regarding the efficacy of antiepileptic drug (AED) prophylaxis in patients with CSDH who undergo bur hole drainage. The authors endeavored to evaluate the efficacy of AED prophylaxis in reducing the incidence of seizures and improving outcome in this patient population.


METHODS
A single surgeon's clinical database (E.S.C.) was analyzed for cases involving bur hole drainage for CSDH. Cases involving nonhemorrhagic subdural effusions as well as acute subdural hemorrhages evacuated by craniotomy were excluded from this study. Patient medical records were evaluated for relevant demographic data, medical history, imaging characteristics, clinical details of the treatment, hospital stay, and discharge summaries.


RESULTS
The authors included 88 patients with bur hole-treated CSDH. Eleven patients (12.5%) suffered at least 1 seizure between hemorrhage onset and discharge from their treatment hospital admission. Seizures were more frequent in women than men (p = 0.030) and least frequent in patients with right-sided lesions (p = 0.030). In a multiple logistic regression model, preoperative initiation of AED prophylaxis was the only significant predictor of the lower incidence of postoperative seizures (OR 0.10, p = 0.013). However, preoperative initiation of AED prophylaxis did not significantly affect outcome at discharge.


CONCLUSIONS
The finding in this study demonstrates that preoperative AED prophylaxis likely reduces the incidence of postoperative seizures in patients with CSDH treated with bur hole drainage. A future prospective randomized study is necessary to evaluate the effect of seizure reduction on clinical outcome.
Grobelny
Bartosz T
BT
Department of Neurological Surgery, Columbia University, College of Physicians and Surgeons, New York, New York, USA. btg2001@columbia.edu
Ducruet
Andrew F
AF
Zacharia
Brad E
BE
Hickman
Zachary L
ZL
Andersen
Kristen N
KN
Sussman
Eric
E
Carpenter
Austin
A
Connolly
E Sander
ES
D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D007839:Functional Laterality; D020200:Hematoma, Subdural, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
D000927:Anticonvulsants