Prophylactic Antiseizure Medication in Patients with Lobar Intracerebral Hemorrhage

Early seizures are a common complication after acute intracerebral hemorrhage (ICH). We tested the hypothesis of whether prophylactic antiseizure medication is associated with lower incidence of early seizures in patients with elevated risk of ICH.

This study involved a retrospective analysis of a prospective observational cohort, including five academic medical centers with a focus on patients presenting spontaneous ICH on hospital admission in the years 2006 through 2023. We assessed the characteristics of acute ICH and the administration of antiseizure medication. In this observational cohort, the administration of antiseizure medication was at the discretion of the treating physician. We focused on the 300 patients with lobar hematoma location. Age, hematoma volume, and sex were included as covariates in an adjusted regression model to evaluate seizure occurrence. We prospectively recorded the use of antiseizure medications and identified the occurrence of early seizures. Additionally, we conducted an exploratory analysis defining patients who were at risk as those with lobar hematomas, age < 65 years, and hematoma volume ≥ 10 mL. Functional outcomes were assessed using modified Rankin Scale scores three months after event.

The median age was 72.0 (interquartile range 62.0-80.0) years, and 158 (53%) were female. An early seizure occurred in 43 (14.3%). In patients who did not receive antiseizure prophylaxis, 34 of 157 (21.6%) had an early seizure, whereas in patients who did receive antiseizure prophylaxis, 9 of 143 (6.3%) had an early seizure. Prophylactic antiseizure medication was associated with a reduced incidence of early seizures (adjusted odds ratio 0.25, 95% confidence interval 0.11-0.54, P = 0.0005) in patients at high risk for early seizures. There was no association between prophylactic medication use and modified Rankin Scale scores at three-month follow-up.

In a retrospective analysis of a multicenter cohort of patients at elevated seizure risk after ICH, prophylactic antiseizure medication was associated with a reduced likelihood of an early seizure.