Prophylactic antiseizure drugs for spontaneous intracerebral hemorrhage: An updated systematic review and meta-analysis

Abstract

Background: There is concern that recommendations on prophylactic antiseizure drugs (PASDs) for patients with spontaneous intracerebral hemorrhage (sICH) are biased by studies using older drugs and no electrographic monitoring. Aims: We performed a systematic review and meta-analysis to determine whether PASDs in patients with sICH reduced seizure occurrence and improved functional outcomes. We included analyses of newer trials, newer antiseizure drugs, and effectiveness in patients with consistent electrographic monitoring. Methods: Medline, Embase, and Cochrane were searched from inception until August 12th, 2022, to identify studies with patients with sICH treated with PASDs, regardless of study design. The studied outcomes were functional status and occurrence of seizures. Results: 14 studies were included, including 6742 patients. Risk of bias was low overall. There was no effect of PASD on seizure occurrence overall (OR 0.73, 95% CI 0.47-1.15) but they were associated with reduced occurrence in studies with electrographic monitoring (OR 0.36, 95% CI 0.18-0.70). There was no effect of PASDs on functional outcomes (OR 1.15; 95% CI 0.91-1.47) or mortality (OR 0.85, 95% CI 0.65-1.11). Conclusions: Prophylactic antiseizure medications after spontaneous intracerebral hemorrhage reduce seizures in studies with EEG monitoring in high-risk patients. However, this benefit did not reflect in improvement of functional outcomes, even in studies with newer, less toxic, antiseizure drugs.

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“…However, there was no effect of PASDs on functional outcomes (OR: 1.15; 95% CI: 0.91-1.47) or mortality (OR: 0.85, 95% CI: 0.65-1.11), even though many studies used levetiracetam. 13 Their results support the current recommendations 14 not to use anti-seizure drugs prophylactically in this group of patients.…”

“…Seizures are not uncommon following ICH, with incidence estimates ranging from 2% to 30%. 13 A common clinical question is whether we should give prophylactic anticonvulsant medication to patients with ICH to prevent seizures. A paper in this issue by Mota Telles et al 13 points out that although current guidelines 14 state there is no benefit in using prophylactic antiseizure drugs (PASDs), some aspects of these recommendations are still debated, and these recommendations are based mostly on studies using old antiseizure drugs, rather than newer drug, such as levetiracetam.…”