title: Hyperammonemia induced by prophylactic administration of antiepileptic drugs during the perioperative period of craniotomy.
abstract: BACKGROUND
  Antiepileptic drugs (AEDs) are increasingly used prophylactically during the perioperative period to prevent epilepsy in patients undergoing craniotomy. Evidence concerning the use of AEDs and the incidence, extent and risk factors of hyperammonemia induced by different types of AEDs is lacking.
  
  
  METHODS
  Patients were divided into groups with 3 different AED regimens, levetiracetam, valproate and carbamazepine regimens, and the blood ammonia concentration and liver and coagulation functions were assessed during the perioperative period.
  
  
  RESULTS
  Sixty-five patients were enrolled consecutively and the postoperative hyperammonemia was found in 46 patients (70.77%), and 45 (97.83%) were asymptomatic. A total of 80.95% of the patients using valproate developed hyperammonemia, and the postoperative blood ammonia concentration continued to rise in 61.90% of these patients. Additionally, valproate had the least impact on liver enzymes. The synthetic function of the liver in patients with higher concentrations of preoperative blood ammonia was more seriously damaged than that in patients with normal postoperative ammonia concentrations.
  
  
  CONCLUSIONS
  Selection of AED for patients undergoing craniotomy should be based on the individual medical situation. Carbamazepine may be a proper choice for the majority of these patients, while valproate is likely to be more appropriate for patients with abnormal liver aminotransferases.
authors: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing 100730, People's Republic of China.
authors: Xiaopeng
authors: X
authors: Guo
authors: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing 100730, People's Republic of China.
authors: Lu
authors: L
authors: Gao
authors: Peking Union Medical College, No. 5 Dongdansantiao, Beijing 100730, People's Republic of China.
authors: Wei
authors: W
authors: Lin
authors: Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing 100730, People's Republic of China.
authors: Yue
authors: Y
authors: Wu
authors: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing 100730, People's Republic of China.
authors: Qiang
authors: Q
authors: Wang
authors: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing 100730, People's Republic of China.
authors: Bing
authors: B
authors: Xing
authors: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing 100730, People's Republic of China. Electronic address: xuzhq1999@126.com.
authors: Zhiqin
authors: Z
authors: Xu
mesh_terms: D000641:Ammonia / Q000097:blood; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects*; D018890:Chemoprevention / Q000009:adverse effects*; D003399:Craniotomy; D004827:Epilepsy / Q000517:prevention & control*; D005260:Female; D006801:Humans; D022124:Hyperammonemia / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period
chemical_list: D000927:Anticonvulsants; D000641:Ammonia
keywords: Antiepileptic drug; Craniotomy; Encephalopathy; Hyperammonemia; Liver function