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Abstract

Introduction: The need for prophylactic antiepileptic drugs (AEDs) remains controversial in patients diagnosed with a non-traumatic subarachnoid hemorrhage (SAH). The primary objective is to compare the incidence of in-hospital seizures among subjects diagnosed with a non-traumatic SAH prescribed AEDs compared to those who did not receive prophylaxis with AEDs. Secondary objectives assess efficacy and tolerability of phenytoin (PHT)/fosphenytoin (fPHT) versus levetiracetam (LEV) among subjects receiving prophylactic AEDs. Hypothesis: AEDs are not effective in preventing seizures in patients with non-traumatic SAH. Methods: This retrospective, single-center, observational study was conducted at Intermountain Medical Center. All individuals admitted from October, 2007 to August, 2011 with a diagnosis of non-traumatic SAH were considered for study enrollment. Patients meeting the following criteria were excluded: age <18 years, a premorbid seizure disorder, hospital stay < 24 hours, and traumatic SAH. Eligible subjects were analyzed based on exposure to AED or no exposure to AED. A seizure was defined as a clinical epileptic event documented by physician (regardless of electroencephalogram confirmation). A Fisher’s exact test was used for analysis of the primary objective. Secondary objectives were analyzed using a binary logistic regression model. Results: 293 patients were screened for eligibility. Of these, 130 patients meet enrollment criteria (n=82 prophylaxis arm; n=48 no prophylaxis arm). Eleven of the 130 patients analyzed developed seizures (8 prior to admission; 3 in the prophylaxis arm; 0 in the no prophylaxis arm). Overall, 3.7% patients in the prophylaxis arm developed seizures compared to 0% in the no prophylaxis arm (p=ns). Furthermore, there were no statistical differences associated with efficacy and tolerability of PHT/ fPHT versus LEV among subjects receiving prophylactic AEDs. Conclusions: There is no difference in the rate of seizures among non-traumatic SAH patients who received AED prophylaxis versus those who did not. Additionally, there were no differences in tolerability or rates of seizures with PHT/fPHT versus LEV.