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The following population, intervention, comparator, and outcome (PICO) questions were assessed: (1) Should ASM versus no ASM be used as seizure prophylaxis in adult patients undergoing supratentorial neurosurgery? (2) If an ASM is used, should levetiracetam (LEV) or phenytoin\/fosphenytoin (PHT) be preferentially used? and (3) Should a long (&gt;\u20097\u00a0days) versus short (\u2264\u20097\u00a0days) duration of prophylaxis be used? The main outcomes were early seizure (\u2264\u200914\u00a0days), late seizures (&gt;\u200914\u00a0days), adverse events, mortality, and functional and cognitive outcomes. We utilized Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to generate recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The initial literature search yielded 1988 articles, and 16 formed the basis of the recommendations. PICO 1: while meta-analysis of randomized controlled trials (RCTs) demonstrated a significant benefit for early seizure prevention, meta-analyses including all study designs was nonsignificant. Further, there were no differences in late seizure or mortality rates, and there was a trend toward higher adverse event rates with ASM. PICO 2: LEV was associated with significantly lower early seizure rates than PHT, and there were trends toward fewer late seizures and adverse events with LEV. PICO 3: only three studies examined the duration of ASM treatment, and there was no significant difference in seizure events between subjects treated for a short versus long duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      We suggest that either prophylactic ASM or no ASM be used for seizure prophylaxis in patients undergoing supratentorial neurosurgery (\n                      <jats:italic>conditional recommendation, low quality of evidence<\/jats:italic>\n                      ). If an ASM is used, we suggest LEV over PHT (\n                      <jats:italic>conditional recommendation, very low quality of evidence<\/jats:italic>\n                      ) for a short duration (\n                      <jats:italic>conditional recommendation, very low quality of evidence<\/jats:italic>\n                      )\n                      <jats:italic>.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12028-026-02522-2","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T17:39:25Z","timestamp":1778002765000},"page":"34-57","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Guidelines for Seizure Prophylaxis in Patients Undergoing Supratentorial Neurosurgery: A Statement for Healthcare Professionals from the Neurocritical Care Society"],"prefix":"10.1007","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2533-9233","authenticated-orcid":false,"given":"A. 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