Long-Versus Short-Term Seizure Prophylaxis After Craniotomy for Clipping in Aneurysmal Subarachnoid Hemorrhage; A Retrospective Cohort Study

Background: Seizures are quite common following subarachnoid hemorrhage (SAH) and due to increased mortality and morbidity in this setting, thus seizure prophylaxis is introduced as a common neurosurgical practice. Investigations are still ongoing to figure out the most efficient seizure prophylaxis guideline. Objectives: To compare the efficacy of two seizures prophylaxis protocols that have been practiced in a tertiary neurovascular center in Southern Iran through a retrospective cohort analysis Methods: A total of 426 patients who were operated due to aneurysmal SAH between September 2007 and March 2016 were included in this retrospective cohort study. From September 2007 to March 2011 the common practice was prophylaxis with phenytoin for 3 - 6 months, which was switched to a shorter 1-month course since March 2011. Seizure control was evaluated in telephoned patients and outpatient records. Results: Out of 426 subjects eligible for this study, 165 (38.7%) took the 1-month (short-term) regimen and 261 (61.3%) took the 3 - 6 months (long-term) regimen. Results revealed that achievement of seizure control was similar for both groups in those without perioperative seizures (P = 0.4); however, with perioperative seizures, the short-term protocol had inferior results for seizure control and higher odds (almost 109-fold) for developing post-operative seizures. Conclusions: Although short-term 1-month seizure prophylaxis with phenytoin provides adequate seizure control for most individuals after SAH, perioperative seizures necessitates a longer course of 3 - 6 month seizure prophylaxis.