The prophylactic use of an antiepileptic drug in intracerebral hemorrhage.

OBJECTIVE: Patients with intracerebral hemorrhage (ICH) are at increased risk for both early seizures and later epilepsy. There is a common, but unproven, practice of prescribing a prophylactic antiepileptic drug (PAED) to prevent seizures, but the safety and efficacy of this practice is unclear, as is the optimal drug for this purpose. The objective of the study is to evaluate whether patients presenting with acute, spontaneous intracerebral hemorrhage (ICH) benefit from prescription of prophylactic antiepileptic drug (PAED).

METHOD: All patients with a discharge diagnosis of acute, spontaneous ICH admitted to our institution in the calendar years 2004 and 2007 were included. We retrospectively reviewed the records for baseline characteristics, hospital course, PAED use, early seizures, length of stay, discharge disposition, and death.

RESULTS: 157 patients met our criteria for review. 46 (29%) patients were placed on a PAED. 12 (7.6%) had early seizures. 11% of patients placed on a PAED had an early seizure versus 6.3% who not placed on a PAED. Death or hospice discharge was less common in patients prescribed a PAED, while length of stay was longer, however neither of these differences were significant after adjustment for multiple comparisons.

INTERPRETATIONS: Our study confirms previous reports that patients with acute, spontaneous ICH are at an increased risk for early seizures. PAED use in our series was not significantly associated with the risk of early seizures, long-term epilepsy, disability, or death.