Antiepileptic Drug Therapy in Neurosurgical Critical Care

Abstract

There are three postoperative situations when the neuroanesthesiologist may encounter the use of antiepileptic drugs (AEDs):

• 1. Prophylactic use after craniotomy for various reasons

• 2. Continuation of preoperative AEDs (with special subcategories after epilepsy surgery or, if used outside an epilepsy indication, for example, for neuropathic pain/trigeminal neuralgia)

• 3. Initiation of AEDs because of a postoperative seizure or status epilepticus (SE)

Although the older generation of AEDs has more drug interactions with perioperative medications, it is the newer AEDs that bring more uncertainty, due to a less-known (but probably much safer) profile or less familiarity with their use and interactions.