Efficacy of Antiepileptic Drug Prophylaxis After Intracranial Aneurysm Repair

Background Early postoperative seizures are a concern after intracranial aneurysm repair, and prophylactic antiepileptic drugs (AEDs) are commonly prescribed to reduce this risk. However, the clinical value of routine AED prophylaxis remains uncertain. This systematic review and meta‐analysis aimed to evaluate the efficacy of AED prophylaxis in preventing early postoperative seizures, focusing exclusively on evidence from clinical trials. Methods Following PRISMA‐ScR guidelines, a comprehensive search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was performed through August 2025 . Eligible studies were clinical trials that compared seizure incidence between patients receiving prophylactic AEDs and those not receiving AEDs after intracranial aneurysm repair. Data extraction included patient characteristics, AED regimen, and seizure‐related outcomes. Results A total of three studies including 771 patients were analyzed for early postoperative seizures following intracranial aneurysm repair. Of these, 497 patients received prophylactic antiepileptic drugs (AEDs), while 274 patients did not receive any AED prophylaxis.The overall incidence of early postoperative seizures was low. In the AED group, 18 of 497 patients (3.6%) experienced a seizure, compared to 5 of 274 patients (1.8%) in the no‐AED group. These findings suggest that routine prophylactic AED use may not be justified for prevention of early postoperative seizures after intracranial aneurysm repair, particularly in endovascularly treated patients. Conclusion Evidence from three clinical trials indicates that routine AED prophylaxis after intracranial aneurysm repair does not significantly lower the risk of early postoperative seizures. Given the low overall incidence of seizures, the widespread use of prophylactic AEDs may not be justified. Future larger‐scale randomized studies are warranted to determine whether selective use of AEDs in high‐risk patients may provide clinical benefit.