Prophylactic administration of levetiracetam accelerates consciousness level and neurological recovery after neurosurgical operation with supratentorial craniotomy – Preliminary report

Background: Seizure frequency after neurosurgery with craniotomy has been widely reported. Postoperative consciousness recovery may be prolonged in such cases due to seizures or factors related to the underlying pathology and/or surgical procedures. However, it remains unclear whether prophylactic administration of antiseizure drugs is effective. Recently, continuous administration of levetiracetam (LEV) was shown to effectively reduce postoperative seizure frequency. Here, we aimed to confirm the postoperative efficacy of LEV and investigate its potential to aid in consciousness level recovery followed by functional recovery. Method: This retrospective, single-center study analyzed the data of 61 patients who underwent supratentorial craniotomy and were divided into two groups: a continuous prophylactic LEV administration group (LEV group; 2000 mg/day for 14 days; 41 patients) or non-continuous prophylactic administration group (Control group; phenytoin 250 mg/day only on the operative day and postoperative day 1; 20 patients). Seizure frequency, the Glasgow coma scale (GCS), and modified Rankin scale (mRS) were evaluated and compared within and between groups. Results: Average age (years ± SD) was 64.0 ± 17.8 in the LEV and 64.3 ± 13.6 in the Control group. Preoperative seizure frequency was 9.8% in the LEV and 0% in the Control group, and postoperatively, it was 4.9% in the LEV and 25% in the Control group. While there were no preoperative differences in GCS between the groups, the postoperative GCS significantly improved in the LEV group starting on postoperative day 3 but only showed improvement in the Control group starting on postoperative day 14. Functional recovery as determined by the mRS indicated significant improvement in the LEV group on postoperative day 8, whereas the control group showed no significant recovery even on postoperative day 14. Conclusion: Continuous LEV administration after neurosurgical operation with craniotomy accelerates recovery from consciousness disturbance and could improve outcomes by allowing aggressive early neurorehabilitation.