Antiseizure Medications in Poststroke Seizures: A Systematic Review and Network Meta-Analysis

Area of Science:

• Neurology
• Pharmacology
• Clinical Research

Background:

• Poststroke seizures (PSS) management requires effective antiseizure medications (ASMs).
• The optimal ASM for PSS is not well-established.
• This study evaluates ASM efficacy and safety in PSS patients.

Purpose of the Study:

• To compare the effectiveness and safety of various ASMs for PSS.
• To identify ASMs with lower seizure recurrence, adverse events, and discontinuation rates.
• To assess mortality associated with different ASMs in PSS.

Main Methods:

• Systematic literature search of electronic databases for PSS patients on ASMs.
• Network meta-analysis using levetiracetam as reference, assessing seizure recurrence, adverse events, discontinuation, and mortality.
• Risk of bias assessment using Cochrane and RoBINS-I tools; certainty of evidence evaluated with GRADE.

Main Results:

• 15 studies (N=18,676) compared 13 ASMs; high risk of bias in most studies.
• Phenytoin showed higher seizure recurrence and adverse events versus levetiracetam (very low-certainty evidence).
• Carbamazepine and phenytoin linked to higher discontinuation; valproic acid and phenytoin to higher mortality (low to moderate-high certainty evidence).
• Levetiracetam, eslicarbazepine, and lacosamide showed fewest recurrences; lamotrigine had fewest adverse events/discontinuations with low mortality.

Conclusions:

• Levetiracetam and lamotrigine demonstrate potential safety and tolerability for PSS.
• High seizure recurrence rates persist in the PSS population despite ASM use.
• Findings require cautious interpretation due to inherent study biases and confounding factors.