Introduction: Intracranial hemorrhage (ICH) is a devastating form of stroke that leads to development of seizures in up to 2%-40% of patients. Seizure prophylaxis in ICH remains controversial and it is unclear if the benefits of antiepileptic drugs (AEDs) outweigh the risk of potential adverse drug effects. The objective of this analysis is to assess the effect of AED on seizure prevention and long term functional outcomes in patients with acute ICH.
Methods: Our group conducted a meta-analysis using the PRISMA guidelines. A literature search was performed of the PubMed, the Cochran Library, and EMBASE databases using the keywords “Anticonvulsants”, “Intracerebral Hemorrhage”, and related subject headings. Articles were screened and included if they assessed the impact of AEDs on long-term functional outcomes in ICH population using multivariate logistic regression analysis. Overall effect sizes were evaluated with forest plots and publication bias was assessed with the Begg’s and Egger’s tests. Long term functional outcomes were assessed at ≥ 3 months post-ICH with either the National Institute of Health Stroke Scale (NIHSS) or the modified Rankin Score (mRS).
Results: A total of 3,912 articles were identified during the intimal review. After screening, 54 articles remained for full review and 6 articles were included in the final analysis. The quality assessment criteria ranged from moderate to high for evidence synthesis. A total of 3,193 patients were included in the analysis. There were no significant association between the use of AEDs after ICH and poor outcome defined as mRS ≥3 or NIHSS ≥15 (OR 1.53 [95% CI: 0.81-2.88] p=0.18, I2=81.7%). Only one trial evaluated the effect AEDs had in prevent post-ICH seizures. Publication bias was not observed in the analysis (Egger’s bias=2.23, P=0.23).
Conclusion: In conclusion, the use of prophylactic AEDs was not associated with improved or worse functional outcomes after acute ICH.