PROCON Study: Preventive Antiepileptic Treatment in Supratentorial Neurosurgery – A Retrospective Before–After Analysis of a Change in Clinical Guidelines
Abstract
BACKGROUND: European guidelines published in 2021 discourage the systematic use of prophylactic antiepileptic drugs (AEDs) in seizure-naïve patients with primary or metastatic brain tumors. This study aimed to assess the impact of discontinuing routine AED prophylaxis on postoperative seizure incidence and neurological outcomes.
■ METHODS: We conducted a single-center retrospective before-after study comparing seizure incidence before and after discontinuation of routine antiepileptic prophylaxis in supratentorial craniotomies. The primary outcome was de novo postoperative seizures. Secondary outcomes included neurological status, associated factors, AED regimens, and adverse events. Univariate analysis was performed; multivariate analysis was not conducted because of the limited number of events.
■ RESULTS: A total of 382 patients were included. The overall incidence of postoperative seizures following supratentorial craniotomy between 2019 and 2022 was 5.5%. Among patients undergoing supratentorial craniotomy, postoperative seizure incidence decreased from 7.5% in the prophylaxis group to 2.9% in the no-prophylaxis group (P � 0.107). Levetiracetam was the predominant AED. Adverse events related to AEDs were rare (1.5%, P � 0.283). Neurological outcomes at 1 month, including functional autonomy (P � 0.743) and lifestyle (P � 0.460), were not significantly different between the 2 groups. Postoperative seizures were more frequently observed in patients undergoing metastasis resection (P � 0.051) and longer surgical procedures (P � 0.062), though not reaching statistical significance.
■ CONCLUSIONS: Stopping routine antiepileptic prophylaxis was not associated with increased postoperative seizures or worse neurological outcomes. Further studies are needed to assess the safety of newer AEDs in the postoperative setting.
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BibTeX
@article{jarno2026procon,
title = {{PROCON Study: Preventive Antiepileptic Treatment in Supratentorial Neurosurgery – A Retrospective Before–After Analysis of a Change in Clinical Guidelines}},
author = {Jean-Rémy Jarno and Aurélie Subileau and Sylvain Gourier and Anaïs Vasseur and Véronique Vermeersch and Eline Ferretti and Romuald Seizeur and Vanessa Saliou and Olivier Langeron and Anais Caillard},
journal = {World Neurosurgery},
year = {2026},
month = oct,
doi = {10.1016/j.wneu.2026.125084},
url = {https://hal.science/hal-05841225v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - PROCON Study: Preventive Antiepileptic Treatment in Supratentorial Neurosurgery – A Retrospective Before–After Analysis of a Change in Clinical Guidelines
AU - Jean-Rémy Jarno
AU - Aurélie Subileau
AU - Sylvain Gourier
AU - Anaïs Vasseur
AU - Véronique Vermeersch
AU - Eline Ferretti
AU - Romuald Seizeur
AU - Vanessa Saliou
AU - Olivier Langeron
AU - Anais Caillard
PY - 2026
DA - 2026/10/27
JO - World Neurosurgery
DO - 10.1016/j.wneu.2026.125084
UR - https://hal.science/hal-05841225v1
AB - BACKGROUND: European guidelines published in 2021 discourage the systematic use of prophylactic antiepileptic drugs (AEDs) in seizure-naïve patients with primary or metastatic brain tumors. This study aimed to assess the impact of discontinuing routine AED prophylaxis on postoperative seizure incidence and neurological outcomes. ■ METHODS: We conducted a single-center retrospective before-after study comparing seizure incidence before and after discontinuation of routine antiepileptic prophylaxis in supratentorial craniotomies. The primary outcome was de novo postoperative seizures. Secondary outcomes included neurological status, associated factors, AED regimens, and adverse events. Univariate analysis was performed; multivariate analysis was not conducted because of the limited number of events. ■ RESULTS: A total of 382 patients were included. The overall incidence of postoperative seizures following supratentorial craniotomy between 2019 and 2022 was 5.5%. Among patients undergoing supratentorial craniotomy, postoperative seizure incidence decreased from 7.5% in the prophylaxis group to 2.9% in the no-prophylaxis group (P � 0.107). Levetiracetam was the predominant AED. Adverse events related to AEDs were rare (1.5%, P � 0.283). Neurological outcomes at 1 month, including functional autonomy (P � 0.743) and lifestyle (P � 0.460), were not significantly different between the 2 groups. Postoperative seizures were more frequently observed in patients undergoing metastasis resection (P � 0.051) and longer surgical procedures (P � 0.062), though not reaching statistical significance. ■ CONCLUSIONS: Stopping routine antiepileptic prophylaxis was not associated with increased postoperative seizures or worse neurological outcomes. Further studies are needed to assess the safety of newer AEDs in the postoperative setting.
SN - 1878-8750
SN - 1878-8769
ER -