Abstract
Objectives
Intracerebral hemorrhage (ICH) has the highest morbidity and mortality rate of any
stroke subtype and clinicians often administer prophylactic antiseizure medications
(ASMs) as a means of preventing post-stroke seizures, particularly following lobar
ICH. However, evidence for ASM efficacy in preventing seizures and reducing disability
is lacking given limited randomized trials. Herein, we report analysis from a large
prospective observational study that evaluates the effect of primary prophylactic
ASM administration on seizure occurrence and disability following ICH.
Materials and methods
Primary analysis was performed on 1630 patients with ICH enrolled in the ERICH study.
A propensity score for administration of prophylactic ASM was developed and patients
were matched by the closest propensity score (difference < 0.1). McNemar's test was
used to compare occurrence of in-hospital seizure and disability, defined by modified
Rankin Score (mRS) ≥ 3 at 3 months post ICH.
Results
Of the 815 matched pairs of patients treated with primary prophylactic ASM, there
was no significant difference in seizure occurrence (p = 0.4631) or disability (p = 0.4653). Subset analysis of 280 matched pairs of patients with primary lobar ICH
similarly revealed no significant difference in seizure occurrence (p = 0.1011) or disability (p = 1.00) between prophylactically treated and untreated patients.
Conclusions
Although current guidelines do not recommend primary prophylactic ASM following ICH,
clinical use remains widespread. Data from the ERICH study did not find an association
between administering primary prophylactic ASM and preventing seizures or reducing
disability following ICH, thus providing evidence to influence clinical practice and
patient care.
Key Words
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Article info
Publication history
Published online: October 26, 2021
Accepted:
September 26,
2021
Received in revised form:
September 11,
2021
Received:
April 21,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106143
Copyright
© 2021 Elsevier Inc. All rights reserved.
