Impact of antiepileptic drugs for seizure prophylaxis on short and long-term functional outcomes in patients with acute intracerebral hemorrhage: A meta-analysis and systematic review

• Published in: Seizure (London, England) Vol. 69; pp. 140 - 146
• Main Authors: Spoelhof, Brian, Sanchez-Bautista, Julian, Zorrilla-Vaca, Andres, Kaplan, Peter W., Farrokh, Salia, Mirski, Marek, Freund, Brin, Rivera-Lara, Lucia
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2019
• Subjects: Anticonvulsants - therapeutic use; Antiepileptic drugs; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - drug therapy; Clinical trials systematic review/meta-analysis; Humans; Intracerebral hemorrhage; Seizure prophylaxis; Seizures - etiology; Seizures - prevention & control; Time Factors; Treatment Outcome; Clinical trials systematic review/meta-analysis; Antiepileptic drugs; Intracerebral hemorrhage; Seizure prophylaxis
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2019.04.017

•Limited number of studies exist evaluating seizure prophylaxis on outcomes in ICH.•Significant heterogeneity exists within published studies.•Seizure prophylaxis is not associated with improved outcomes after acute ICH. The purpose of this analysis is to assess the effect of antiepileptics (AEDs) on seizure prevention and short and long term functional outcomes in patients with acute intracerebral hemorrhage. The meta-analysis was conducted using the PRISMA guidelines. A literature search was performed of the PubMed, the Cochrane Library, and EMBASE databases. Search terms included “Anticonvulsants”, “Intracerebral Hemorrhage”, and related subject headings. Articles were screened and included if they were full-text and in English. Articles that did not perform multivariate regression were not included. Overall effect size was evaluated with forest plots and publication bias was assessed with the Begg’s and Egger’s tests. A total of 3912 articles were identified during the initial review. After screening, 54 articles remained for full review and 6 articles were included in the final analysis. No significant association between the use of AEDs after ICH and functional outcome (OR 1.53 [95%CI: 0.81–2.88] P = 0.18, I2 = 81.7%). Only one study evaluated the effect AEDs had in preventing post-ICH seizures. The use of prophylactic AEDs was not associated with improved short and long outcomes after acute ICH. This analysis supports the 2015 AHA/ASA recommendation against prophylactic AEDs (class III; level of evidence b).