Review of the Utility of Prophylactic Anticonvulsant Use in Critically Ill Patients With Intracerebral Hemorrhage

Spontaneous atraumatic intracerebral hemorrhage (sICH) accounts for 10% to 15% of strokes a year and results in significant morbidity and mortality for survivors. The sICH-related, 30-day mortality is 30% to 50% with a significant proportion occurring in the acute phase, often in the first 48 hours,1 which may be a reflection of early withdrawal of life-sustaining therapy based on perceived poor neurological prognosis.2,3 Cerebrovascular disease, including sICH, is the most common cause of acute symptomatic seizures and localization-related epilepsy in adults, accounting for ≈3.2% to 10.7% of epilepsy.4–6 Spontaneous ICH patients typically develop seizures early after their hemorrhage,7–9 but the association between early seizures and late seizures/epilepsy remains uncertain. Our understanding of risk factors for developing seizures and epilepsy, and the role of antiseizure medications in preventing poststroke seizures and epilepsy, is based mainly on retrospective analyses. To date, there are limited data on the impact of seizures, epilepsy, and antiseizure medications on functional and cognitive outcomes in patients with sICH. The goal of this nonsystematic review is to summarize the available literature, focusing on the role of seizure prophylaxis in the immediate and long-term post-sICH periods.To identify key articles for inclusion, MEDLINE on the Ovid platform (through February 14, 2016) and Embase and newer (unindexed/in process) articles from PubMed were searched using the following terms or combination of terms Anticonvulsants, Seizures, Cerebral Hemorrhage, Intracranial Hemorrhage, Nontraumatic, Spontaneous and Critical Care. All identified references were then cross-referenced to select further articles for inclusion. Non-English studies and studies isolated to infants and children were excluded. DefinitionsSeizures occur at various time points after sICH, from onset to weeks, months, and years afterward. Onset or immediate seizures occur either at ictus or within 24 hours of injury and may in fact be …