Alyssa Sykuta, BCCCP, PharmD,
Critical Care Pharmacist
Riverside Methodist Hospital
Columbus, Ohio
Disclosure information not submitted.
Amber King, BCPS, PharmD
Associate Professor, Department of Pharmacy Practice
Thomas Jefferson University, United States
Disclosure information not submitted.
Title: Seizure Prophylaxis Selection and Outcomes in Patients With Intracranial Hemorrhage
Introduction: Seizures are a feared complication of intracranial hemorrhage as they may worsen midline shift and cerebral ischemia. Despite lack of guideline support for prophylactic use of antiepileptic drugs (AEDs), these agents continue to be used Little data exists regarding the safety and efficacy of newer AEDs for preventing seizures in patients with intracranial hemorrhage. The primary endpoint of this study was incidence of seizures in patients with and without AED prophylaxis. Secondary endpoints were incidence of seizures between different AEDs, factors associated with AED use, and factors associated with AED choice in intracranial hemorrhage.
Methods: This was a single-center, retrospective cohort study of 137 patients admitted to a neurosciences or surgical ICU with a diagnosis of ICH.
Results: The total incidence of clinical and electrographic seizures was 6.7%, all of which occurred in patients who were receiving AED prophylaxis. All seizures occurred in patients receiving levetiracetam (LEV) for prophylaxis. Factors associated with AED use included location of hemorrhage and surgical intervention. Choice of AED was primarily driven by attending physician, with LEV initially selected for 112 patients (92.5%). Thirteen patients (10.7%) were switched from LEV to LCM, most commonly for agitation attributed to LEV.
Conclusions: This retrospective study adds to existing evidence that AED prophylaxis does not reduce risk of seizures in intracranial hemorrhage. Seizures occurred exclusively in patients receiving seizure prophylaxis, although no seizures were reported among patients initially receiving LCM. Prospective studies are warranted to further characterize the safety and efficacy of LCM as an alternative for seizure prophylaxis in intracranial hemorrhage.