Effectiveness of perioperative antiepileptic drug prophylaxis for early and late seizures following oncologic neurosurgery: a meta-analysis

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OBJECTIVE

The purpose of this meta-analysis was to evaluate the impact of perioperative antiepileptic drug (AED) prophylaxis on short- and long-term seizure incidence among patients undergoing brain tumor surgery. It is the first meta-analysis to focus exclusively on perioperative AED prophylaxis among patients undergoing brain tumor surgery.

METHODS

The authors searched PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and the System for Information on Gray Literature in Europe for records related to perioperative AED prophylaxis for patients with brain tumors. Risk of bias in the included studies was assessed using the Cochrane risk of bias tool. Incidence rates for early seizures (within the first postoperative week) and total seizures were estimated based on data from randomized controlled trials. A Mantel-Haenszel random-effects model was used to analyze pooled relative risk (RR) of early seizures (within the first postoperative week) and total seizures associated with perioperative AED prophylaxis versus control.

RESULTS

Four RCTs involving 352 patients met the criteria of inclusion. The results demonstrated that perioperative AED prophylaxis for patients undergoing brain tumor surgery provides a statistically significant reduction in risk of early postoperative seizures compared with control (RR = 0.352, 95% confidence interval 0.130–0.949, p = 0.039). AED prophylaxis had no statistically significant effect on the total (combined short- and long-term) incidence of seizures.

CONCLUSIONS

This meta-analysis demonstrates for the first time that perioperative AED prophylaxis for brain tumor surgery provides a statistically significant reduction in early postoperative seizure risk.

ABBREVIATIONS AAN = American Association of Neurology; AED = antiepileptic drug; AMSTAR = A Measurement Tool to Assess Systematic Reviews; CI = confidence interval; PRISMA = Preferred Reporting Items for Systematic Review and Meta-Analysis; RCT = randomized controlled trial; RR = risk ratio; SIGLE = System for Information on Gray Literature in Europe.

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  • Appendices A and B (PDF 2.12 MB)

Article Information

Correspondence Jeffrey Bruce: The Neurological Institute of New York, New York, NY. jnb2@cumc.columbia.edu.

INCLUDE WHEN CITING Published online April 27, 2018; DOI: 10.3171/2017.10.JNS172236.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Flow diagram of our systematic literature search (adapted from PRISMA).27 Figure is available in color online only.

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    Risk of bias assessment (adapted from the Cochrane Handbook for Systematic Reviews of Interventions).15 Figure is available in color online only.

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    Forest plot for pooled meta-analysis of effect of AED prophylaxis on incidence of early seizures (Mantel-Haenszel [M-H] random-effects model). Point estimates of relative risks are indicated with boxes, the areas of which are proportional to the weight afforded each study. Ninety-five percent CIs are indicated by horizontal lines and a diamond. Figure is available in color online only.

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    Forest plot for pooled meta-analysis of effect of AED prophylaxis on incidence of early and late (total) seizures (Mantel-Haenszel random-effects model). Point estimates of relative risks are indicated with boxes, the areas of which are proportional to the weight afforded each study. Ninety-five percent CIs are indicated by horizontal lines and a diamond. Figure is available in color online only.

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    Funnel plots for early seizure incidence (left) and total seizure incidence (right). Each dashed vertical line indicates the point estimate of pooled relative risk. Ninety-five percent of studies would be expected to fall within the diagonal dashed lines in the absence of heterogeneity or biases. Figure is available in color online only.

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