Comparative Analysis of Single Versus Dual Anti-Epileptic Drugs for Controlling Intra-Operative and Early Postoperative Seizure in Glioma Patients Undergoing an Awake Craniotomy; A Retrospective Study

INTRODUCTION: Awake craniotomy (AC) is the standard approach for tumors of eloquent areas. However, concerns remain regarding the perioperative seizure risks and complications requiring general anesthesia (GA) or termination. METHODS: This retrospective cohort study included patients who underwent awake craniotomy for Glioma resection. Patients were divided into two groups based on their seizure control medication: Group S (N = 29) received one AED, while Group D (N = 26) received dual AEDs. We compared intraoperative seizures (IOS) and post-operative seizures (POS) rates between Groups S and D. Additionally, we evaluated the risk factors associated with POS and the 1-month post-operative Karnofsky Performance Scale (1M-KPS). RESULTS: This study considered a power of 0.9 so the effect size obtained was 0.866. 55 patients (41.8% female) with a median age of 39.0 (IQR 33.0-51.0) entered. The rate of IOS was 8 (27.6%) in Group S and 3 (11.5%) in Group D, with no statistically significant difference. (p = 0.137) POS occurred in 7 (24.1%) patients in group S and 2 (7.7%) patients in group D, (p = 0.100) pointing out no significant difference. The length of hospital stay (p = 0.606) and the length of ICU stay (p = 0.141), Post-op KPS, and 1M-KPS were not significantly different between the two cohorts (p = 0.131 and p = 0.217, respectively). The occurrence of POS was influenced neither by adjuvant therapy nor IDH1 mutation. The univariate and multivariate regression models showed pre-op KPS and the extent of resection had a significant effect on 1M-KPS. CONCLUSIONS: The addition of a second AED did not significantly affect POS prevention, IOS rate, or 1M-KPS improvement. Further research is needed for optimized strategies and improved patient outcomes.