Nerosurgery and Treatment Strategy using Anti-Epileptic Drugs (AEDs) in Postoperative Seizures: A matter of Debate
Abstract
Background: AEDs are frequently prescribed to control postoperative seizures after nero-surgery. The aim of this study was to provide a review related to evidence-based-pharmacotherapy after neurosurgery.
Materials and Methods: A total of 300 research papers were selected in order to achieve a provision for this study at the Isfahan Kashani Neurosurgery ward as a pioneer center in Isfahan/Iran.
Results: The great percentage of patients was getting antiepileptic management since neurosurgical procedure, mainly as monotherapy, with a reasonable amount of conservative and newer AEDs. Supervision after a neurosurgical process is an extensively argued subject, as evidence is rather incomplete, particularly for the newer AEDs. Early seizures signify a well-recognized hazard feature for postsurgical epilepsy, as they associate with the rigorousness of the cerebral maltreatment. There are numerous drug-drug interactions with both older and newer AEDs. According to recent publication newer AEDs such as levetiracetam and zonisamide have a tendency toward less seizure attack and an enhanced acceptability than traditional AEDs, although disparities were not statistically considerable. Adverse events increased more often, subsequent to phenytion prescription as first line monotherapy plan. Treatment using chemo-radiotherapy and steroids are common in a high percentage of patients after neuro-surgery. Therefore prescription of AEDs such as carbamazepine, phenytion and phenobarbital could increase the clearance (CL) of corticosteroids and anticancer agents.
Conclusion: Administration of older AEDs after neuro-surgery might affects pharmacokinetics parameters such as: 1) a decrease in bioavailability of other drugs (F↓) due to potent induction or inhibition of CYP450 related to metabolic events and 2) a decrease in clinical efficacy (CE↓) that unfortunately could results to therapeutic failure after neurosurgeon.