Short-term Perioperative Anticonvulsant Prophylaxis for the Surgical Treatment of Low-risk Patients with Intracranial Aneurysms

Nontraumatic Acetabular Fracture Sustained during Convulsive Seizure Following Surgery for an Unruptured Intracranial Aneurysm: A Case Report

Acetabular fracture usually is related to high-energy traumatic injury or falls from heights and directly caused by seizures without trauma is extremely rare. We report a 71-years-old man who sustained a left acetabular fracture secondary to generalized seizure after clipping of an unruptured aneurysm without trauma and any risk for fracture. The patient had an aneurysm was arising from the bifurcation of the left internal carotid artery and the posterior communicating artery. After the clipping, the patient had three times tonic-clonic seizures for 1 min and resulted in an acetabular fracture. In our case, acetabular fracture might relate to expose of massive stress generated by strong muscle contraction. Acetabular fracture causes severe complication, such as pelvic hemorrhage and organ injury. Therefore, early recognition and diagnosis of such fracture and risk factor provide an opportunity to secure a better outcome.

A muliticenter retrospective study of the actual using patterns and clinical effects of topiramate in patients with neurosurgical disease

BACKGROUND AND PURPOSE

This study is to investigate the actual using patterns and clinical effects of topiramate in patients with neurosurgical disease as antiepileptic drugs (AEDs) in 94 korean multicenters.

METHODS

A total of 7,152 patients who had taken topiramate for at least 3 months between August 2008 and February 2009 were eligible to participate in this study. We evaluated demographic data, disease entities, duration of topiramate administration, initial and subsequent dosage adjustment, concomitant AEDs, the frequency of seizure reduction, and adverse events.

RESULTS

Topiramate was commonly prescribed in stroke (38%) and head trauma group (36%). In the dosage of topiramate, the mean initial dosage was 65 mg/day, and the mean maintenance dosage was adjusted into 105 mg/day. The mean duration of the initial dosage for topiramate administration was 24 days, and the mean duration of the maintenance dosage was 125 days, respectively. Among groups with prophylactic administration, 98% did not develop convulsion and among groups with therapeutic administration, 2% was ineffective to control seizure. After taking topiramate, 2% patients showed adverse events, that sensory aberration was the most common.

CONCLUSIONS

These results suggest that topiramate prescribe widely in diverse neurosurgical disorders, and effective in reduction of seizure frequency, and does not cause serious adverse effects comparable with old AEDs.