E-059 Seizure prophylaxis in aneurysmal subarachnoid haemorrhage: a survey of leading cerebrovascular centres

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Abstract

Introduction

Seizure in the days following subarachnoid haemorrhage occurs in 6–18% of patients with a ruptured intracranial aneurysm. Not only may seizure confound the neurologic exam, but it may also place patients with an unsecured lesion at increased risk for re-rupture. Seizure prophylaxis in this patient population is controversial, and there remains no level I data regarding the effectiveness of seizure prophylaxis after subarachnoid haemorrhage.

Methods

A brief 8-question survey was sent to 20 major US centres with cerebrovascular neurosurgical specialisation. Respondents were asked about institutional practices regarding seizure prophylaxis, including preferred medications and duration of therapy, as well as seizure surveillance with electroencephalography.

Results

All 20 survey requests were completed and returned. 10 respondents (50%) reported routine use of anti-convulsant for seizure prophylaxis, while 10 (50%) did not. Among respondents using prophylaxis, levetiracetam was the drug of choice for most (80%), while phenytoin was used to a varying degree by two centres. The duration of levetiracetam prophylaxis ranged from 1–30 days following SAH. No centres employed EEG routinely, however most supported EEG use when the neurologic exam was unreliable or inexplicably declining. Nineteen (95%) respondents agreed that a trial randomising patients to levetiracetam or no anti-seizure medication is warranted at this time, and all 20 (100%) believed that such a trial would be ethical.

Conclusions

The routine use of seizure prophylaxis following aneurysmal subarachnoid haemorrhage is controversial. Among a sampling of 20 major academic centres, one half administers seizure prophylaxis, while the other half does not. The majority believes a trial randomising patients to receive seizure prophylaxis is both timely and ethical.

Disclosures

M. Dewan: None. J. Mocco: None.

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