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Adrian L. Rabinowicz, David L. Ginsburg, Christopher M. DeGiorgio, Peggy S. Gott and Steven L. Giannotta

their potential side effects. 6 We retrospectively studied 21 patients who underwent surgery for unruptured intracranial aneurysms in order to identify the risk of postoperative seizures, factors predictive of seizures, and the response to discontinuation of antiepileptic drugs. Clinical Material and Methods We evaluated 28 patients who underwent elective surgery for unruptured intracranial aneurysms between 1984 and 1989. All patients were operated on by the same neurosurgeon (S.L.G.). Data were gathered from clinic charts and patient interviews. Information

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Axel J. Rosengart, Dezheng Huo, Jocelyn Tolentino, Roberta L. Novakovic, Jeffrey I. Frank, Fernando D. Goldenberg and R. Loch Macdonald

.9) phenobarbital & carbamazepine 15 (0.4) all three drugs 5 (0.1) Predictors of AED Use Antiepileptic drug treatment varied dramatically according to study country ( Fig. 2 ). The intraclass correlation coefficient describing the extent of variation in AED use between countries was 0.22 (95% CI 0.20–0.24, χ 2 = 1594; p < 0.001). Seven of the 21 study countries enrolled more than 100 patients each, and these groups amounted to 87% of all patients. The rate of AED use varied from 7 to 93% of cases, with a greater than 50% prevalence rate in Australia, Canada, Italy

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Kim J. Burchiel

In this issue, Komotar and colleagues 1 report the results of their “meta-analysis” of publications describing the incidence of postoperative seizures with and without the use of prophylactic antiepileptic drugs (AEDs) in patients with supratentorial meningiomas. They identified 16 articles, 13 of which provided seizure outcome for patients treated with AED prophylaxis, 3 of which did the same for patients not treated with AEDs, and 3 of which compared patient groups. The patients in these series varied with respect to their duration of anticonvulsant

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Daniel Ikeda and E. Antonio Chiocca

, and a poorer prognosis. 4 , 10 Although a history of seizure prior to diagnosis of glioblastoma has been reported to be associated with increased survival, 11 many have found seizures in patients with HGGs to be associated with postoperative complications, tumor progression, and end of life. 7 , 14 , 15 The treatment of patients with brain tumors and epilepsy poses a difficult problem. Patients with brain tumors tend to express multidrug-resistant proteins, which inhibit the availability of antiepileptic drugs (AEDs) to brain parenchyma. 3 , 17 Moreover, enzyme

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Roberto C. Heros

Dr. Rosengart and colleagues have performed a very careful post-hoc statistical analysis of the results of the four published double-blind, placebo-controlled tirilazad trials. Their aim was to examine the pattern of use and the effect of prophylactic antiepileptic drugs (AEDs). Two of their results are of considerable interest and the third and most important is of potentially great significance. The first two results were that prophylactic AEDs were used in 65% of the patients in the study and that there was no consistency in the pattern of use, which

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Ricardo J. Komotar, Daniel M. S. Raper, Robert M. Starke, J. Bryan Iorgulescu and Philip H. Gutin

, patient characteristics, and primary findings by 2 independent researchers (D.M.S.R., J.B.I.). The total number of patients for each study was extracted and divided into cohorts according to perioperative AED use. Data for all patients were recorded when available, including mean age, sex, tumor location, preoperative signs and symptoms, previous surgery, preexisting seizure disorder or AED use, and operative approaches. Antiepileptic drug use, extent of resection, adjuvant treatments, mortality, and recurrences were noted. Postoperative seizures were classified as

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Greg D. Guthrie and Sam Eljamel

the Health Informatics Centre data set. All patients were treated with standard therapy including surgery, radiotherapy, and chemotherapy. Particular attention was given to the type of AED each patient received. The choice of AED was at the discretion of the treating team and department policy. Antiepileptic drugs were given only after the onset of the first seizure. Patients were then divided into 2 main categories: Group A included all patients who had not received an AED (138 patients) and Group B included those who had (98 patients). Group B was then subdivided

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Evan F. Joiner, Brett E. Youngerman, Taylor S. Hudson, Jingyan Yang, Mary R. Welch, Guy M. McKhann II, Alfred I. Neugut and Jeffrey N. Bruce

neoplasm,” “brain cancer,” “glioma,” “glioblastoma,” “GBM,” “cerebral metastasis,” “cerebral metastases,” “meningioma,” “prophylactic,” “antiepileptic,” “anticonvulsant,” “prophylaxis,” “AED,” “phenytoin,” “phenobarbital,” “divalproex,” “valproic acid,” “carbamazepine,” “levetiracetam,” “etiracetam,” “gabapentin,” “lamotrigine,” and “topiramate.” Terms were combined using appropriate Boolean operators. No limitations in language, publication type, or publication period were applied. Gray literature (print and electronic works not published by commercial publishers

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Bartosz T. Grobelny, Andrew F. Ducruet, Brad E. Zacharia, Zachary L. Hickman, Kristen N. Andersen, Eric Sussman, Austin Carpenter and E. Sander Connolly Jr.

had nonhemorrhagic subdural effusions (hygromas) or if their medical records were insufficient to reliably determine the presence/absence of seizures either on presentation or at any point after their treatment hospital admission. For each patient, age, sex, admission GCS score; dates and times of seizure onset, bur hole drainage, and antiepileptic drug initiation; and number of days taking AEDs, daily AED levels, and discharge mRS score were recorded. Patient medical histories were also reviewed for date and location of previous cranial surgery, epilepsy

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Nandor Ludvig, Hai M. Tang, Shirn L. Baptiste, Geza Medveczky, Jonathan K. Vaynberg, Jacqueline Vazquez-DeRose, Dimitre G. Stefanov, Orrin Devinsky, Jacqueline A. French, Chad Carlson and Ruben I. Kuzniecky

, prohibiting its use for therapeutic purposes. 11 , 18 , 40 However, the single delivery of 1.0–2.5 mM muscimol into the rat or monkey neocortex via the transmeningeal route can exert more powerful antiepileptic effects than clinically used AEDs 2 and can leave the animal's behavior intact. 21 These favorable pharmacological properties of muscimol, along with its water solubility and stability in solution, 21 made this compound the drug of choice for the SPD. However, the safety of long-term transmeningeal muscimol delivery into the neocortex has been unknown. The