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Antiepileptic Drugs for Preventing Seizures in Patients with Chronic Subdural Hematoma
Pedro Moura Branco1, Bernardo Oliveira Ratilal1, Joao Costa2
1Department of Neurosurgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
Insights
Prophylactic antiepileptic drugs for chronic subdural hematoma (CSH) lack proven benefit in preventing seizures, despite potential risks. Evidence is insufficient, especially for new-generation drugs in elderly patients.
Area of Science:
- Neurosurgery
- Neurology
- Clinical Pharmacology
Background:
- Chronic subdural hematoma (CSH) is a common intracranial bleed, particularly in the elderly, often linked to minor trauma.
- Epileptic seizures are a significant complication of CSH, occurring pre- or post-operatively, with incidence rates between 3% and 23%.
- Current clinical practice regarding prophylactic antiepileptic drug (AED) use in CSH patients varies widely, from routine administration to complete avoidance.
Purpose of the Study:
- To critically evaluate the evidence for prophylactic AED use in preventing seizures in patients diagnosed with CSH.
- To identify patient subgroups, such as the elderly and alcohol abusers, who might benefit most from prophylactic AEDs.
- To discuss the potential safety advantages of newer AEDs in this context.
Main Methods:
- Systematic literature review of controlled randomized trials and retrospective studies on prophylactic AEDs for CSH.
- Analysis of existing evidence regarding the efficacy and risk/benefit profile of AEDs in CSH patients.
- Discussion of current clinical practice variations and the need for updated research.
Main Results:
- No controlled randomized trials definitively evaluate the risk/benefit of prophylactic anticonvulsants for CSH.
- Retrospective studies show contradictory results and are often outdated, not considering newer AEDs.
- The efficacy of prophylactic AEDs in preventing seizures in CSH patients remains inconclusive.
Conclusions:
- There is insufficient evidence to support the routine prophylactic use of AEDs for seizure prevention in CSH patients.
- Further research, including randomized controlled trials evaluating newer AEDs, is needed to clarify the role and safety of prophylactic treatment.
- Specific patient subgroups may warrant further investigation for potential benefits, alongside careful consideration of adverse event profiles.
Abstract:
Chronic subdural hematoma (CSH) is an accumulation of blood within the intracranial subdural space. It is associated with minor traumatic events and affects mostly the elderly. CSH can be effectively treated surgically with good outcomes, although the recurrence rate is high. Epileptic seizures are one of the major complications associated with CSH, either in the pre or postoperative period. The incidence rate of new onset seizures after CSH diagnosis ranges between 3% and 23%. However, the benefit of using prophylactic antiepileptic drugs in these patients is controversial with significant variations in clinical practice. It ranges from routine to total absence of use in this clinical context. The best current evidence does not allow any firm conclusion on whether such prophylactic treatment is effective, that is if it prevents the development of epileptic seizures. Furthermore, these drugs are associated with important adverse events. A systematic literature review found no controlled randomized trials evaluating the risk/benefit of the prophylactic use of anticonvulsants for people with CSH and retrospective studies showing contradictory results. Moreover, these observational studies are outdated and do not evaluate new generation drugs. Herein, we discuss the evidence for the use of antiepileptic drugs for preventing seizures in patients with CSH, with a particular focus on the subgroup of people most likely to benefit (such as the elderly and alcohol abusers), as well as the possible safety advantages of the new antiepileptic drugs.
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