ABSTRACT
Our review of the literature is basically focused on the primary prophylaxis of early seizures after surgery of cerebral supratentorial tumors, with the aim of suggesting several recommendations in medical antiepileptic treatment to avoid this kind of seizures which occur immediately after surgery. In conclusion, it is recommended to provide criteria for prophylaxis of early seizures after surgery of cerebral supratentorial tumors. ItÌs recommended a one week treatment with antiepileptic drugs in patients who didnt have seizures jet, starting immediately after the surgical treatment. If seizures appear during progress of the disease, a large period treatment will be needed. Preferred antiepileptic treatment is intravenous and with a low interactions profile. Levetiracetam, followed by valproic acid seem to be most appropriated drugs due to their properties and protective effects, particularly for our patients requirements. These recommendations are considered a general proposal to effective clinical management of early seizures after surgery, not taking into account the single circumstances of our patients. Always, clinical features of the patients could modify even significantly these guides in the benefit of each patient.
Subject(s)
Neurosurgery , Seizures , Anticonvulsants/therapeutic use , Humans , Spain , Supratentorial NeoplasmsABSTRACT
Con la finalidad de proponer una serie de recomendaciones del tratamiento médico antiepiléptico, en el perioperatorio de los tumores cerebrales supratentoriales, se realiza una revisión de la literatura enfocada sobre todo a la profilaxis primaria de las crisis epilépticas precoces acaecidas en el postoperatorio inmediato. Se concluye que es recomendable pautar profilaxis primaria antiepiléptica poscirugía durante una semana en los pacientes con tumor cerebral supratentorial que no han presentado crisis epilépticas. Si las crisis aparecen durante la evolución de la enfermedad, es necesario pautar un tratamiento a largo plazo. Dadas las características de estos pacientes, se recomienda usar un fármaco antiepiléptico con presentación por vía intravenosa y un perfil bajo de interacciones. El levetiracetam, seguido del valproato, parecen ser los más adecuados. Dichas recomendaciones deben considerarse como una guía general de manejo, pudiendo ser modificadas, incluso de manera significativa, por las circunstancias propias de cada caso clínico (AU)
Our review of the literature is basically focused on the primary prophylaxis of early seizures after surgery of cerebral supratentorial tumors, with the aim of suggesting several recommendations in medical antiepileptic treatment to avoid this kind of seizures which occur immediately after surgery. In conclusion, it is recommended to provide criteria for prophylaxis of early seizures after surgery of cerebral supratentorial tumors. It's recommended a one week treatment with antiepileptic drugs in patients who didn't have seizures jet, starting immediately after the surgical treatment. If seizures appear during progress of the disease, a large period treatment will be needed. Preferred antiepileptic treatment is intravenous and with a low interactions profile. Levetiracetam, followed by valproic acid seem to be most appropriated drugs due to their properties and protective effects, particularly for our patients requirements. These recommendations are considered a general proposal to effective clinical management of early seizures after surgery, not taking into account the single circumstances of our patients. Always, clinical features of the patients could modify even significantly these guides in the benefit of each patient (AU)
Subject(s)
Humans , Epilepsy/prevention & control , Brain Neoplasms/surgery , Supratentorial Neoplasms/surgery , Craniotomy/adverse effects , Postoperative Complications/prevention & control , Practice Patterns, Physicians'ABSTRACT
INTRODUCTION: Evidence-based medicine establishes guidelines for clinical decision-making in which priority is given to processes that have the highest level of evidence. Although these guidelines provide valuable general guidance, the information is partial, because oftentimes obtaining evidence on antiepileptic drugs is promoted by commercial expectations and not by clinical priorities. Furthermore, the guidelines tend to classify different types of epilepsy into large groups, often without contemplating the different syndromes. Expert opinions are subject to criticism on the basis of methodology and their authoritarian aspect, although they can supplement medical literature and advice on specific clinical situations quickly and efficiently. OBJECTIVES: This review seeks to incorporate scientific evidence and expert opinion into drug treatment for epilepsy. METHODS: To analyze this issue, a review of the literature was conducted by means of PubMed searches. CONCLUSION: We have found that in all types of epilepsy [except in focal epilepsy in children where a new drug (oxcarbamazepine) is considered to be the first choice for initial treatment], classic drugs (valproic acid in idiopathic generalized epilepsy and carbamazepine in focal epilepsy) are recommended as long as there are no contraindications due to adverse effects or concomitant use of other drugs that interact with the antiepileptics. However, despite the general recommendations, it can be deduced from the studies and reflections on the subject that the decision as to whether to start treatment or not, as well as the drug of choice, must be made on a case-by-case basis, taking into account the patient's personal and social circumstances.
Subject(s)
Anticonvulsants/pharmacology , Anticonvulsants/therapeutic use , Biomedical Research , Epilepsy/drug therapy , Evidence-Based Medicine , Humans , Practice Guidelines as TopicABSTRACT
BACKGROUND: Despite the correct use of antiepileptic drugs, control of seizures is not possible in 20% to 30% of people with epilepsy. This group of patients is considered to suffer from drug-resistant epilepsy, a clinical situation that can be caused by certain syndromes in which surgery can be used to bring the seizures under control. REVIEW SUMMARY: Determining the suitability of the surgical treatment and the best approach always requires a full assessment, which includes video-electroencephalogram (EEG) monitoring, neuropsychological examination, and structural magnetic resonance imaging. In some patients it may be necessary to perform functional imaging tests and intracranial electrode recordings. These tests make it possible to confirm that the patient does indeed have epilepsy, identify the type of epilepsy, determine the severity of the seizures, and locate the epileptogenic zone. The best surgical results are obtained in patients with small epileptogenic lesions which can be totally resected. Nevertheless, in many patients in whom complete control is not achieved after surgery, the improvement in control of the seizures also has a positive impact on their quality of life. Some surgical techniques (partial resections, corpus callosotomy, subpial transection, electrical stimulation of the vagus nerve, and deep brain stimulation) have a palliative effect. CONCLUSION: The aim of this review is to update knowledge on the indications for surgery and electrical stimulation in the management of epilepsy.
