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Background <p>There is significant heterogeneity related to the use of prophylactic antiseizure medications (ASM) following supratentorial craniotomy.</p> Methods <p>We conducted a systematic review and meta-analysis assessing ASM primary prophylaxis in adults hospitalized following supratentorial neurosurgery with no prior seizure history. The following population, intervention, comparator, and outcome (PICO) questions were assessed: (1) Should ASM versus no ASM be used as seizure prophylaxis in adult patients undergoing supratentorial neurosurgery? (2) If an ASM is used, should levetiracetam (LEV) or phenytoin/fosphenytoin (PHT) be preferentially used? and (3) Should a long (&gt; 7&#xa0;days) versus short (≤ 7&#xa0;days) duration of prophylaxis be used? The main outcomes were early seizure (≤ 14&#xa0;days), late seizures (&gt; 14&#xa0;days), adverse events, mortality, and functional and cognitive outcomes. We utilized Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to generate recommendations.</p> Results <p>The initial literature search yielded 1988 articles, and 16 formed the basis of the recommendations. PICO 1: while meta-analysis of randomized controlled trials (RCTs) demonstrated a significant benefit for early seizure prevention, meta-analyses including all study designs was nonsignificant. Further, there were no differences in late seizure or mortality rates, and there was a trend toward higher adverse event rates with ASM. PICO 2: LEV was associated with significantly lower early seizure rates than PHT, and there were trends toward fewer late seizures and adverse events with LEV. PICO 3: only three studies examined the duration of ASM treatment, and there was no significant difference in seizure events between subjects treated for a short versus long duration.</p> Conclusions <p>We suggest that either prophylactic ASM or no ASM be used for seizure prophylaxis in patients undergoing supratentorial neurosurgery (<i>conditional recommendation, low quality of evidence</i>). If an ASM is used, we suggest LEV over PHT (<i>conditional recommendation, very low quality of evidence</i>) for a short duration (<i>conditional recommendation, very low quality of evidence</i>)<i>.</i></p>

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Guidelines for Seizure Prophylaxis in Patients Undergoing Supratentorial Neurosurgery: A Statement for Healthcare Professionals from the Neurocritical Care Society

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月5日

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  • A. Shaun Rowe,
  • Jamie Ullman,
  • Emily L. Johnson,
  • Emily J. Gilmore,
  • DaiWai Olson,
  • Appaji Rayi,
  • Eljim Tesoro,
  • Yuhong Yuan,
  • Sahar Zafar,
  • Jennifer A. Frontera

摘要

Background

There is significant heterogeneity related to the use of prophylactic antiseizure medications (ASM) following supratentorial craniotomy.

Methods

We conducted a systematic review and meta-analysis assessing ASM primary prophylaxis in adults hospitalized following supratentorial neurosurgery with no prior seizure history. The following population, intervention, comparator, and outcome (PICO) questions were assessed: (1) Should ASM versus no ASM be used as seizure prophylaxis in adult patients undergoing supratentorial neurosurgery? (2) If an ASM is used, should levetiracetam (LEV) or phenytoin/fosphenytoin (PHT) be preferentially used? and (3) Should a long (> 7 days) versus short (≤ 7 days) duration of prophylaxis be used? The main outcomes were early seizure (≤ 14 days), late seizures (> 14 days), adverse events, mortality, and functional and cognitive outcomes. We utilized Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to generate recommendations.

Results

The initial literature search yielded 1988 articles, and 16 formed the basis of the recommendations. PICO 1: while meta-analysis of randomized controlled trials (RCTs) demonstrated a significant benefit for early seizure prevention, meta-analyses including all study designs was nonsignificant. Further, there were no differences in late seizure or mortality rates, and there was a trend toward higher adverse event rates with ASM. PICO 2: LEV was associated with significantly lower early seizure rates than PHT, and there were trends toward fewer late seizures and adverse events with LEV. PICO 3: only three studies examined the duration of ASM treatment, and there was no significant difference in seizure events between subjects treated for a short versus long duration.

Conclusions

We suggest that either prophylactic ASM or no ASM be used for seizure prophylaxis in patients undergoing supratentorial neurosurgery (conditional recommendation, low quality of evidence). If an ASM is used, we suggest LEV over PHT (conditional recommendation, very low quality of evidence) for a short duration (conditional recommendation, very low quality of evidence).