The Effect of Postoperative Anticonvulsant Prophylaxis after Aneurysmal Subarachnoid Hemorrhage

Kim, Young Jin; Chun, Min Ho

Abstract

OBJECTIVE
The purposes were to describe the incidence of seizures after aneurysmal subarachnoid hemorrhage (SAH) and to evaluate the effect of postoperative anticonvulsant prophylaxis. METHOD: Subjects were 89 patients with aneurysmal SAH who were undergone craniotomy and clipping of aneurysm. We evaluated the relationship between the incidence of seizure and the use of antiepileptic drug. And we sought to identify putative risk factors associated with seizure after SAH. RESULTS: Ten patients (11.2%) had one or more epileptic seizures. One patient had only preoperative seizure and nine patients including four patients who had prehospital or preoperative seizure developed seizures during follow upafter surgery. All but two of these nine patients were receiving an antiepileptic drug at the time of seizure. Blood samples for antiepileptic drug plasma levels were taken more than once in 81 patients. Of total blood samples, therapeutic serum levels were achieved in 73.5% of the seizure group and in 68.6% of the no-seizure group (p>0.05). Drug-related side effects occurred in 22.5% (20/89). Significant risk factors for seizure included early seizure (4/5) and rebleeding after surgical clipping of aneurysm (2/3). CONCLUSION: We think that the preventive effect of anti convulsant drug on late seizure is unclear in patients with aneurysmal SAH.