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Published on: May 16, 2019
Effect of Primary Prophylactic Antiseizure Medication for Seizure Prevention Following Intracerebral Hemorrhage in
Krupa Savalia1, Padmini Sekar2, Charles J Moomaw2
1Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Insights
Prophylactic antiseizure medications (ASMs) do not prevent seizures or reduce disability after intracerebral hemorrhage (ICH). This study found no significant difference in outcomes for patients receiving ASMs compared to those who did not.
Area of Science:
- Neurology
- Neurosurgery
- Stroke Medicine
Background:
- Intracerebral hemorrhage (ICH) carries high morbidity and mortality.
- Clinicians often use prophylactic antiseizure medications (ASMs) after ICH, especially lobar ICH, to prevent seizures.
- Evidence supporting ASM efficacy in preventing seizures and reducing disability is limited.
Purpose of the Study:
- To evaluate the effect of primary prophylactic ASM administration on seizure occurrence and disability following ICH.
- To provide evidence to inform clinical practice regarding ASM use in ICH patients.
Main Methods:
- Analysis of 1630 patients with ICH from the ERICH study.
- Development of a propensity score for prophylactic ASM administration.
- Matching of patients using the closest propensity score and comparison using McNemar's test for in-hospital seizures and 3-month modified Rankin Scale (mRS) scores.
Main Results:
- No significant difference in seizure occurrence (p=0.4631) or disability (p=0.4653) between 815 matched pairs receiving prophylactic ASMs and those who did not.
- Subset analysis of 280 matched pairs with lobar ICH also showed no significant difference in seizure occurrence (p=0.1011) or disability (p=1.00).
Conclusions:
- Primary prophylactic ASMs are not associated with preventing seizures or reducing disability after ICH.
- Findings support current guidelines that do not recommend primary prophylactic ASMs for ICH.
- This evidence can help influence clinical practice and improve patient care decisions.
Objectives:
Intracerebral hemorrhage (ICH) has the highest morbidity and mortality rate of any stroke subtype and clinicians often administer prophylactic antiseizure medications (ASMs) as a means of preventing post-stroke seizures, particularly following lobar ICH. However, evidence for ASM efficacy in preventing seizures and reducing disability is lacking given limited randomized trials. Herein, we report analysis from a large prospective observational study that evaluates the effect of primary prophylactic ASM administration on seizure occurrence and disability following ICH.
Materials And Methods:
Primary analysis was performed on 1630 patients with ICH enrolled in the ERICH study. A propensity score for administration of prophylactic ASM was developed and patients were matched by the closest propensity score (difference < 0.1). McNemar's test was used to compare occurrence of in-hospital seizure and disability, defined by modified Rankin Score (mRS) ≥ 3 at 3 months post ICH.
Results:
Of the 815 matched pairs of patients treated with primary prophylactic ASM, there was no significant difference in seizure occurrence (p = 0.4631) or disability (p = 0.4653). Subset analysis of 280 matched pairs of patients with primary lobar ICH similarly revealed no significant difference in seizure occurrence (p = 0.1011) or disability (p = 1.00) between prophylactically treated and untreated patients.
Conclusions:
Although current guidelines do not recommend primary prophylactic ASM following ICH, clinical use remains widespread. Data from the ERICH study did not find an association between administering primary prophylactic ASM and preventing seizures or reducing disability following ICH, thus providing evidence to influence clinical practice and patient care.
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