Prescribing Antiepileptic Drugs to Treat Seizures in Stroke Patients Could Improve Prognosis

Prescribing antiepileptic drugs (AED) to treat symptomatic seizure in patients experiencing intracerebral hemorrhage (ICH) could improve prognosis at discharge and the 3-month mark, according to new research presented at the 2022 European Stroke Organisation Conference. As many as 15% to 20% of ICH patients will suffer an acute symptomatic seizure.

“[The] impact on prognosis of prescription of antiepileptic drugs are controversial, especially after early onset seizures,” wrote Miriam Paul-Arias, MD, Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, and co-authors.

Researchers retrospectively reviewed a cohort of 234 patients with ICH who registered at their hospital during the acute phase of stroke. The authors also classified the seizures experienced as “early or late onset” depending on when they manifested, either before or later than 7 days following ICH. Current European guidelines recommend prescription only in the aftermath of a late seizure and not for early-onset events.

Forty (17%) patients had at least 1 seizure after ICH. Of that group, 31 (77.5%) received AED treatment, most (28; 90.3%) with levetiracetam, 2 with lacosamide, and 1 with lamotrigine.

Researchers evaluated patient outcomes using the Modified Ranking Score. Final analysis showed that patients who had received AEDs exhibited a significantly better outcome, at discharge and at 3 months post-discharge than those who had not received a prescription.

“Our results suggest that receiving treatment with AEDs after early seizure could be related to a better evolution at 3 months, and therefore, could be indicated,” Paul-Arias et al concluded.

References

Paul-Arias M, Baraldés-Rovira M, Mauri-Capdevlia G, et al. Prescription of antiepileptic drugs in seizures after intracerebral hemorrhage is associated with better prognosis. Poster presented at: European Stroke Organisation Conference; May 4-6, 2022; Lyon, France.