Abstracts

Rationale: Although seizures are a recognized complication of non-traumatic intracranial hemorrhage, the utility of prophylactic antiepileptic drugs (AEDs) in reducing the incidence of seizures or improving outcomes is still unclear. The use of prophylactic AEDs is not standardized and may be associated with worse outcomes (Messe et al., 2009). Prophylaxis in traumatic intracranial hemorrhage has been shown to decrease the incidence of early seizures (Temkin et al., 1990), but this has not been fully addressed for nontraumatic hemorrhage. The purpose of this study is to evaluate the incidence of seizures and outcomes in patients admitted with nontraumatic intracranial hemorrhage with and without prophylactic AEDs.Methods: ICD-9 diagnosis codes for nontraumatic intracranial hemorrhage, including intraparenchymal, intraventricular, subdural, and subarachnoid hemorrhage admitted in 2009 were evaluated. Discharge summaries were reviewed for type of hemorrhage, use of prophylactic AEDs, occurrence of a clinical or electrographic seizure, and disposition. Patients were excluded if they had a seizure at onset, a prior seizure disorder, or history of trauma.Results: One hundred and seventy four patients with the diagnosis of nontraumatic hemorrhage were identified. Of those, 110 met inclusion criteria. Thirty one had subarachnoid hemorrhage (28.2%), 29 had intraparenchymal hemorrhage (26.4%), 19 had subdural hemorrhage (17.3%), 4 had intraventricular hemorrhage (3.6%), 3 had cerebellar hemorrhage (2.7%), and 24 had a combination of hemorrhage locations (21.8%). Prophylactic AEDs were started in 84 (76%) of the 110 patients. During the admission, 8.3% of the patients given prophylaxis and 19.2% of the patients not given prophylaxis had seizures. Of patients who received prophylaxis, 18% were discharged to either home or an acute rehabilitation facility, compared with 49% of those who did not receive prophylaxis.Conclusions: Patients with intracranial hemorrhage who were started on prophylaxis had a lower incidence of seizures during their hospitalization. However, the prophylaxis group had an overall worse outcome based on discharge disposition. Further investigation with a prospective randomized trial is necessary to elucidate the value of prophylactic AEDs in patients with nontraumatic hemorrhages.