Uncertain Effectiveness of Prophylactic Anticonvulsive Medication in Predicting Cognitive Outcome of Neurosurgical Patients

World Neurosurg. 2019 Jul;127:e692-e696. doi: 10.1016/j.wneu.2019.03.243. Epub 2019 Apr 1.

Abstract

Objectives: To evaluate the influence of prophylactic anticonvulsive medication, above all levetiracetam monotherapy, in predicting the cognitive outcome of neurosurgical patients with post-traumatic brain injury, intracerebral hemorrhage, and encephalic tumors.

Methods: We examined data concerning 232 of 327 adult patients admitted to the Neurorehabilitation Department of the San Raffaele Hospital (Milan, Italy) after discharge from the Neurosurgery Department. Cognitive status was evaluated by means of the "Mini-Mental State" examination and the Functional Independence Measure at baseline and at the end of a rehabilitation care with an average duration of about four weeks.

Results: The vast majority of the patients were treated with levetiracetam. Our data showed a negative role of antiepileptic drugs on cognitive recovery in a cohort of neurosurgical patients.

Conclusions: Knowing thoroughly the effects of antiepileptic drugs in rehabilitation outcome is of fundamental importance. This study represents the only large series analyzing these aspects in the rehabilitation of neurosurgical patients. Antiepileptic drugs should be managed to ensure patients the best possible cognitive outcome. Further evidence from good-quality trials is required to assess the clinical effectiveness of prophylactic anticonvulsive medication in predicting the cognitive outcome of neurosurgical patients who are treated with rehabilitation.

Keywords: Antiepileptic drugs; Cognitive outcome; Levetiracetam; Neurosurgery; Side effects.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anticonvulsants / administration & dosage*
  • Cognition / drug effects*
  • Cognition / physiology
  • Female
  • Humans
  • Italy / epidemiology
  • Levetiracetam / administration & dosage*
  • Male
  • Middle Aged
  • Neurosurgical Procedures / adverse effects
  • Neurosurgical Procedures / trends*
  • Pre-Exposure Prophylaxis / methods
  • Pre-Exposure Prophylaxis / trends*
  • Prognosis
  • Retrospective Studies
  • Treatment Outcome
  • Uncertainty*

Substances

  • Anticonvulsants
  • Levetiracetam