Are post intracerebral hemorrhage seizures prevented by anti-epileptic treatment?

Prophylactic antiepileptic treatment in patients with non-traumatic, non-aneurysmatic spontaneous intracerebral hemorrhage (SICH) is controversial. The purpose of our study was to assess the occurrence of seizures and neurologic outcome in SICH patients who were treated with valproic acid or a placebo for a period of one month and follow-up of one year in a hospital inpatient neurologic department and ambulatory clinic settings. The study is a prospective randomized, double-blind, placebo-controlled clinical trial. The patients were treated for one month with either valproic acid (VPA) or placebo immediately after a SICH and were followed-up for one year to evaluate seizure rate and neurologic function as measured by the National Institutes of Health Stroke Scale (NIHSS). Seventy-two patients participated in the study--36 were treated with VPA and 36 with placebo. During follow-up, 21% of the patients developed seizures. A by-treatment difference in incident seizures was not detected. However, a difference between reduction in early seizures and late one was observed in the VPA group. VPA-treated patients exhibited improved neurological outcome as measured by NIHSS. Early prophylaxis with VPA in SICH patients did not prevent the occurrence of seizures post intracerebral hemorrhage, but was found to reduce early seizures. VPA-treated patients had improved NIHSS scores, suggesting that this treatment may confer some neuroprotective effect. Further studies with a larger number of patients and with other antiepileptic drugs are needed to properly clarify this finding.