Abstract 132: Utility of Prophylactic Antiepileptic Drug Administration on Seizure Prevention and Disability Following Intracerebral Hemorrhage in the Ethnic/Racial Variations of Intracerebral Hemorrhage Study

Abstract

Background & Purpose: Intracerebral hemorrhage (ICH) has the highest morbidity and mortality rate of any stroke subtype and clinicians often administer prophylactic anti-epileptic drugs (AEDs) as a means of preventing post-stroke seizures, particularly following lobar hemorrhage (LH). However, evidence for AED efficacy in preventing seizures and reducing disability is lacking given difficulty executing randomized prospective trials. We report an analysis of data from a large prospective observational study of ICH that evaluates the effect of prophylactic AED administration on seizure occurrence and disability following ICH. Methods: Primary analysis was performed on 1636 patients with ICH enrolled in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study with subset analysis completed in patients with primary LH (n=562). A propensity score for administration of prophylactic AED was based on age, gender, race, ICH volume, location, presence of intraventricular hemorrhage, ventriculostomy, surgery, GCS, history of ischemic stroke, diabetes, sepsis, dementia, alcohol use and illicit drug use; patients were matched by the closest propensity score (difference <0.1). McNemar’s test was used to compare the occurrence of seizure and disability, defined by Modified Rankin Score (mRS) ≥ 3 at 3 months post ICH, in the treated and untreated groups. Similarly, analysis was performed on patients with LH by matching 281 treated patients with 281 untreated patients. Results: Of the 818 matched pairs of patients who were treated with prophylactic AEDs, there was no significant difference in seizure occurrence (p=0.6799) or disability (p=0.6521). Subset analysis of 281 matched pairs of patients with LH revealed no significant difference in seizure occurrence (p=0.1161) or disability (p=0.9146) between those treated with prophylactic AED and untreated patients. Conclusions: While prophylactic AED treatment of ICH is not recommended by current guidelines, clinical use remains widespread. Data from the large prospective ERICH study clearly reveal lack of efficacy in administering AEDs for prevention of seizures and reduction of disability following ICH, thus providing strong evidence to influence clinical practice and patient care.