May 6, 2019

Meta-Analysis and Systematic Review Supports the Recommendation Against Prophylactic Antiepileptic Drugs After Acute Intracerebral Hemorrhage

PURPOSE: The purpose of this analysis is to assess the effect of antiepileptics (AEDs) on seizure prevention and short and long term functional outcomes in patients with acute intracerebral hemorrhage.

METHOD: The meta-analysis was conducted using the PRISMA guidelines. A literature search was performed of the PubMed, the Cochrane Library, and EMBASE databases. Search terms included “Anticonvulsants”, “Intracerebral Hemorrhage”, and related subject headings. Articles were screened and included if they were full-text and in English. Articles that did not perform multivariate regression were not included. Overall effect size was evaluated with forest plots and publication bias was assessed with the Begg’s and Egger’s tests.

RESULTS: A total of 3912 articles were identified during the initial review. After screening, 54 articles remained for full review and 6 articles were included in the final analysis. No significant association between the use of AEDs after ICH and functional outcome (OR 1.53 [95%CI: 0.81-2.88] P = 0.18, I2 = 81.7%). Only one study evaluated the effect AEDs had in preventing post-ICH seizures.

CONCLUSIONS: The use of prophylactic antiepileptic drugs was not associated with improved short and long outcomes after acute intracerebral hemorrhage. This analysis supports the 2015 AHA/ASA recommendation against prophylactic antiepileptic drugs (class III; level of evidence b).

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