Ulus Travma Acil Cerrahi Derg. 2023; 29(8): 883-889 | DOI: 10.14744/tjtes.2023.06554

Is prophylactic anti-convulsive treatment necessary in subdural hematomas?

Mehmet Ozan Durmaz¹, Adem Dogan², Mehmet Can Ezgü¹, Ali Kaplan^1
1Department of Neurosurgery, Gulhane Education and Research Hospital, Ankara-Türkiye
²Department of Neurosurgery, Sehitkamil State Hospital, Gaziantep-Türkiye

BACKGROUND: Subdural hematoma (SDH) is usually an emergent clinical condition in neurosurgery. The relationship between the SDH and epilepsy is not well established. Therefore, the use of anti-convulsive treatment in patients with SDH is controversial. The aim of this study is to analyze the presence of seizures in patients who underwent surgery for SDH.
METHODS: Patients who were operated on for SDH in our department between 2016 and 2021 were reviewed retrospectively. Demographic features, Glasgow Coma Scale (GCS) score at admission, type of SDH, location, etiology, type of surgical intervention, presence of seizures, and re-operation were evaluated.
RESULTS: There were 175 patients with SDH. There is a statistically significant difference between the frequency of seizures and the type of SDH. More seizures were observed in acute SDH than in the others. There is also a statistically significant difference between the GCS score and the frequency of seizures. Patients with a GCS score <12 at admission had more frequent seizures than patients with a score of 12 or higher. No statistically significant difference was found between factors such as etiology, re-operation, hematoma location, and the development of seizures.
CONCLUSION: Anti-convulsive treatment may be recommended in patients with acute SDH and a low GCS score at admission. Further studies with larger series should be performed to determine the most appropriate anti-convulsive agent for patients with SDH.

Keywords: Anti-convulsive treatment, epilepsy; subdural hematoma; surgery.

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Subdural hematomlarda profilaktik antikonvülsif tedavi gerekli midir?

Mehmet Ozan Durmaz¹, Adem Dogan², Mehmet Can Ezgü¹, Ali Kaplan^1
1Gülhane Eðitim ve Araþtýrma Hastanesi, Beyin ve Sinir Cerrahisi Kliniði, Ankara, Türkiye
²Þehitkamil Devlet Hastanesi, Beyin Cerrahisi Kliniði, Gaziantep, Türkiye

AMAÇ: Subdural hematom (SDH) beyin cerrahisinde genellikle acil bir klinik durumdur. SDH ve epilepsi arasýndaki iliþki iyi kurulmamýþtýr. Bu nedenle SDH’li hastalarda antikonvülzif tedavinin kullanýmý tartýþmalýdýr. Bu çalýþmanýn amacý, SDH nedeniyle ameliyat edilen hastalarda nöbet varlýðýný analiz etmektir.
GEREÇ VE YÖNTEM: 2016-2021 yýllarý arasýnda kliniðimizde SDH nedeniyle ameliyat edilen hastalar geriye dönük olarak incelendi. Hastalarýn demografik özellikleri, baþvuru anýndaki Glasgow koma skalasý (GKS), SDH’nin tipi, yerleþimi, etiyolojisi, cerrahi giriþimin tipi, nöbet varlýðý ve reoperasyon gibi faktörler deðerlendirildi.
BULGULAR: SDH nedeniyle ameliyat edilen 175 hasta incelendi. Nöbet sýklýðý ile SDH tipi arasýnda istatistiksel olarak anlamlý fark saptanmýþtý. Akut SDH’de diðerlerine göre daha fazla nöbet gözlendi. GKS skoru ile nöbet sýklýðý arasýnda da istatistiksel olarak anlamlý bir fark vardýr. Baþvuru anýnda GKS skoru 12’nin altýnda olan hastalar, 12 veya daha yüksek olan hastalara göre daha sýk nöbet geçirmiþlerdi. Etiyoloji, reoperasyon, hematom yerleþimi ve nöbet geliþimi gibi faktörler arasýnda istatistiksel olarak anlamlý fark bulunmadý.
SONUÇ: Akut SDH ve baþvuru anýnda GKS skoru düþük olan hastalarda antikonvülsif tedavi önerilebilir. SDH’li hastalarda en uygun antikonvülzif ajanýn belirlenmesi için daha geniþ serili ileri çalýþmalara ihtiyaç vardýr.

Anahtar Kelimeler: Epilepsi, subdural hematom; cerrahi; antikonvülzif tedavi.

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