Antiepileptic drugs such as phenytoin, levetiracetam, and valproic acid may not result in improvements in neurologic outcomes or reductions in seizure activity in patients with spontaneous intracerebral hemorrhage (ICH), study results published in the Annals of Emergency Medicine suggest.

The study was a meta-analysis of 8 trials that included 4211 adult patients with spontaneous ICH. Only studies that compared prophylactic antiepileptic therapy vs no preventive therapy were included in the analysis.

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The researchers included 4 studies of phenytoin, 2 studies of levetiracetam, 1 study of valproic acid, and 1 that did not specify the primary antiepileptic therapy used. Poor clinical outcome at the longest recorded follow-up, defined as a modified Rankin Scale score >3 or all-cause mortality, comprised the primary outcome. An additional secondary outcome was seizure incidence at follow-up.

A total of 4 studies had a maximum follow-up of 90 days, and 1 study used either 12 months, 30 days, hospital discharge, or hospitalization duration as the follow-up period. In the pooled meta-analysis of 7 studies that evaluated several antiepileptic agents vs control, there was no difference between the 2 groups in terms of neurologic outcome or all-cause mortality (odds ratio [OR], 0.99; 95% CI, 0.66-1.49; heterogeneity [I2], 64.5). There was also no difference between antiepileptic agents and controls in terms of incident seizures (OR, 0.89; 95% CI, 0.52-1.51; I2, 0). The investigators found no evidence indicating publication bias in the studies.

A limitation of the meta-analysis was the inclusion of predominantly observational and retrospective studies.

The findings from this study do not appear to “support routine use of an antiepileptic drug for primary seizure prevention in adults with spontaneous intracerebral hemorrhage.” The study investigators do, however, believe that “there remains a need for further randomized data with consideration of patient injury severity.”

Disclosure: None of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Long B, April MD. Do antiepileptics reduce the risk of poor neurologic outcomes and prevent seizures in patients with spontaneous intracerebral hemorrhage [published online July 17, 2019] Ann Emerg Med. doi:10.1016/j.annemergmed.2019.06.013