Prophylactic antiepileptic drugs in meningioma surgery – survey of clinical practice in the UK

Abstract

INTRODUCTION: Over 50% of patients with meningioma do not present with epileptic seizures. Anti‐epileptic drugs (AEDs) cause adverse effects in ~20% of patients. Guidelines recommend against routine use of prophylactic AEDs. The aim of this study was to evaluate the use of prophylactic AEDs in meningioma surgery in the UK.MATERIALS AND METHODS: Online survey of UK neurosurgeons to determine: (a) use of prophylactic AED; (b) preferred AED, dose and duration of use; (c) tumour location and radiological factors that influence use of AED; (d) willingness to participate in a future randomised controlled trial.RESULTS: 60 completed surveys from 25 neurosurgical centres. Use of prophylactic AED was 'almost never' in 37/61 (61%); 'rarely' 10/61 (16%); 'often' 8/61 (13%) and 'almost always' 6/61 (10%). 42 surgeons had prescribed AEDs at some point. Sphenoid (24/49; 49%) and olfactory (17/49; 35%) location, oedema (26/49; 53%) and mass effect/midline shift (20/49; 41%) were factors associated with prophylactic AED use. Leviteracetam (n=23) and phenytoin (n=18) were the commonest AEDs used. Commonest duration of AED prescription was 7 days (n=18) and 14 days (n=8), but ranged from single dose at surgery to 3 months. 80% of surgeons would participate in a randomised controlled trial. CONCLUSIONS: Most UK neurosurgeons follow guidelines and do not routinely prescribe prophylactic AEDs. Sphenoid and olfactory meningiomas and those with oedema are more likely to receive prophylactic AEDs which suggests neurosurgeons are more concerned about the consequences of seizures in these patients. A randomised controlled trial is required to provide class I evidence of those patients that may benefit from prophylactic AEDs in meningioma surgery.