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Postoperative de novo epilepsy after craniotomy: a nationwide register-based cohort study

BACKGROUND AND OBJECTIVES: The risks of postoperative risk of epilepsy after a craniotomy is widely believed to be raised. A study is warranted to quantify the risks for any neurosurgical indication. In this unselected register-based nationwide cohort study with virtually complete follow-up, the sho...

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Autores principales: Giraldi, Laura, Vinsløv Hansen, Jørgen, Wohlfahrt, Jan, Fugleholm, Kåre, Melbye, Mads, Munch, Tina Nørgaard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8921591/
https://www.ncbi.nlm.nih.gov/pubmed/34845003
http://dx.doi.org/10.1136/jnnp-2021-326968
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author Giraldi, Laura
Vinsløv Hansen, Jørgen
Wohlfahrt, Jan
Fugleholm, Kåre
Melbye, Mads
Munch, Tina Nørgaard
author_facet Giraldi, Laura
Vinsløv Hansen, Jørgen
Wohlfahrt, Jan
Fugleholm, Kåre
Melbye, Mads
Munch, Tina Nørgaard
author_sort Giraldi, Laura
collection PubMed
description BACKGROUND AND OBJECTIVES: The risks of postoperative risk of epilepsy after a craniotomy is widely believed to be raised. A study is warranted to quantify the risks for any neurosurgical indication. In this unselected register-based nationwide cohort study with virtually complete follow-up, the short-term and long-term cumulative risks of postoperative de novo epilepsy for all major neurosurgical indications were estimated. METHODS: The study was based on 8948 first-time craniotomy patients in Denmark 1 January 2005 to 31 December 2015 with follow-up until 31 December 2016. The patients were classified according to their underlying neurosurgical pathology. Patients with preoperative epilepsy were excluded. The postcraniotomy risks of de novo epilepsy were estimated using the Aalen-Johansen estimator in a multistate model. RESULTS: The overall cumulative 1-year risk of postcraniotomy de novo epilepsy was 13.9% (95% CI 13.2 to 14.6). For patients with intracranial tumour the cumulative 1-year risk was 15.4% (95% CI 14.4 to 16.5), for spontaneous intracranial haemorrhage 11.3% (95% CI 10.1 to 12.6), for traumatic intracranial haemorrhage 11.1% (95% CI 9.6 to 12.9), for cerebral abscess 27.6% (95% CI 22.8 to 33.5) and for congenital malformations 3.8% (95% CI 1.3 to 11.7). The 6-month, 1-year and 5-year risks for all major indications by specific subtypes are provided. CONCLUSIONS: The cumulative risk of de novo epilepsy following craniotomy is high for patients with any indication for craniotomy, as compared with the background population. The results provide comprehensive data to support future recommendations regarding prophylactic antiepileptic treatment and driving restrictions.
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spelling pubmed-89215912022-03-25 Postoperative de novo epilepsy after craniotomy: a nationwide register-based cohort study Giraldi, Laura Vinsløv Hansen, Jørgen Wohlfahrt, Jan Fugleholm, Kåre Melbye, Mads Munch, Tina Nørgaard J Neurol Neurosurg Psychiatry Neurosurgery BACKGROUND AND OBJECTIVES: The risks of postoperative risk of epilepsy after a craniotomy is widely believed to be raised. A study is warranted to quantify the risks for any neurosurgical indication. In this unselected register-based nationwide cohort study with virtually complete follow-up, the short-term and long-term cumulative risks of postoperative de novo epilepsy for all major neurosurgical indications were estimated. METHODS: The study was based on 8948 first-time craniotomy patients in Denmark 1 January 2005 to 31 December 2015 with follow-up until 31 December 2016. The patients were classified according to their underlying neurosurgical pathology. Patients with preoperative epilepsy were excluded. The postcraniotomy risks of de novo epilepsy were estimated using the Aalen-Johansen estimator in a multistate model. RESULTS: The overall cumulative 1-year risk of postcraniotomy de novo epilepsy was 13.9% (95% CI 13.2 to 14.6). For patients with intracranial tumour the cumulative 1-year risk was 15.4% (95% CI 14.4 to 16.5), for spontaneous intracranial haemorrhage 11.3% (95% CI 10.1 to 12.6), for traumatic intracranial haemorrhage 11.1% (95% CI 9.6 to 12.9), for cerebral abscess 27.6% (95% CI 22.8 to 33.5) and for congenital malformations 3.8% (95% CI 1.3 to 11.7). The 6-month, 1-year and 5-year risks for all major indications by specific subtypes are provided. CONCLUSIONS: The cumulative risk of de novo epilepsy following craniotomy is high for patients with any indication for craniotomy, as compared with the background population. The results provide comprehensive data to support future recommendations regarding prophylactic antiepileptic treatment and driving restrictions. BMJ Publishing Group 2022-04 2021-11-29 /pmc/articles/PMC8921591/ /pubmed/34845003 http://dx.doi.org/10.1136/jnnp-2021-326968 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Neurosurgery
Giraldi, Laura
Vinsløv Hansen, Jørgen
Wohlfahrt, Jan
Fugleholm, Kåre
Melbye, Mads
Munch, Tina Nørgaard
Postoperative de novo epilepsy after craniotomy: a nationwide register-based cohort study
title Postoperative de novo epilepsy after craniotomy: a nationwide register-based cohort study
title_full Postoperative de novo epilepsy after craniotomy: a nationwide register-based cohort study
title_fullStr Postoperative de novo epilepsy after craniotomy: a nationwide register-based cohort study
title_full_unstemmed Postoperative de novo epilepsy after craniotomy: a nationwide register-based cohort study
title_short Postoperative de novo epilepsy after craniotomy: a nationwide register-based cohort study
title_sort postoperative de novo epilepsy after craniotomy: a nationwide register-based cohort study
topic Neurosurgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8921591/
https://www.ncbi.nlm.nih.gov/pubmed/34845003
http://dx.doi.org/10.1136/jnnp-2021-326968
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