Prophylactic Levetiracetam for Seizure Control After Cranioplasty: A Multicenter Prospective Controlled Study

Objective To study efficacy and safety of prophylactic levetiracetam (LEV) administration in adults undergoing cranioplasty. Methods We prospectively enrolled and randomly divided 200 adults undergoing cranioplasty into 2 groups: LEV (prophylactic LEV for 24 weeks) and control (no prophylactic antiepileptic drugs). Demographic and clinical characteristics; occurrence of postoperative seizure; changes in IQ, memory quotient, and activities of daily living scores; and postoperative side effects during hospital stay were analyzed at 2-, 24-, and 48-week follow-up visits. Results Significant differences were found between groups in both early-stage seizures in the initial 2 weeks and late-stage seizures in the 3–24 weeks after cranioplasty ( P P  = 0.0020). Patients with abnormal preoperative or postoperative electroencephalography (EEG) with spikes or sharp waves presented with an increased number of postoperative seizures compared with patients with normal EEG readings at 48 weeks. Significant differences were found between patients with postoperative seizures and patients without postoperative seizures in regard to changes in IQ, memory quotient, activities of daily living, and patient satisfaction scores ( P Conclusions Postoperative seizure is a common complication of cranioplasty, especially in patients with preoperative or postoperative abnormal EEG with spikes or sharp waves. Prophylactic LEV administration significantly reduced postcranioplasty seizures during LEV usage and had few side effects.