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Prophylactic Antiseizure Drugs for Spontaneous Intracerebral Hemorrhage: An Updated Systematic Review and Meta-analysis.

BACKGROUND
There is concern that recommendations on prophylactic antiseizure drugs (PASDs) for patients with spontaneous intracerebral hemorrhage (sICH) are biased by studies using older drugs and no electrographic monitoring.


AIMS
We performed a systematic review and meta-analysis to determine whether PASDs in patients with sICH reduced seizure occurrence and improved functional outcomes. We included analyses of newer trials, newer antiseizure drugs, and effectiveness in patients with consistent electrographic monitoring.


METHODS
Medline, Embase, and Cochrane were searched from inception until August 12th, 2022, to identify studies with patients with sICH treated with PASDs, regardless of study design. The studied outcomes were functional status and occurrence of seizures.


RESULTS
14 studies were included, including 6742 patients. Risk of bias was low overall. There was no effect of PASD on seizure occurrence overall (OR 0.73, 95% CI 0.47-1.15) but they were associated with reduced occurrence in studies with electrographic monitoring (OR 0.36, 95% CI 0.18-0.70). There was no effect of PASDs on functional outcomes (OR 1.15; 95% CI 0.91-1.47) or mortality (OR 0.85, 95% CI 0.65-1.11).


CONCLUSIONS
Prophylactic antiseizure medications after spontaneous intracerebral hemorrhage reduce seizures in studies with EEG monitoring in high-risk patients. However, this benefit did not reflect in improvement of functional outcomes, even in studies with newer, less toxic, antiseizure drugs.