Lesson 1 of 1
PACU Literature Review #16
- The incidence of early seizures after intracerebral hemorrhage reaches 30% when subclinical seizures are diagnosed by continuous EEG. Current guidelines do not recommend prophylactic antiseizure treatment in this setting
- To assess whether prophylactic levetiracetam would reduce the risk of acute seizures in patients with intracerebral hemorrhage
- Parallel-group, double-blind, randomized, placebo-controlled, investigator-led, phase 3 trial in three hospitals in France.
Study Intervention & Comparison
- Levetiracetam 500mg IV q12h vs matching placebo
- Primary Outcome
- A clinical or electrographic seizure occurred in the first 72 hr in 3 (16%) patients in the levetiracetam group vs 10 (43%) in the placebo group (OR 0.16, p=0.043). Of note, all seizures recorded in this time period were electrographic
- Secondary Outcomes
- Six seizures were recorded on cEEG monitoring in the levetiracetam group vs 158 in the placebo group (p=0.0021)
- Median duration of seizure on cEEG was shorter in levetiracetam group (67 sec vs 780 sec, p=0.028)
- One patient in the placebo group had an early clinical seizure (between 72 hr and 30 days) vs none in the levetiracetam group (p>0.99)
- Levetiracetam might be effective in preventing acute seizures in intracerebral hemorrhage, but larger studies are needed to determine whether seizure prophylaxis improves functional outcome in patients with intracerebral hemorrhage.
- Gilmore EJ, Maciel CB, Hirsch LJ, Sheth KN. Review of the utility of prophylactic anticonvulsant use in critically ill patients with intracerebral hemorrhage. Stroke 2016; 47: 2666–72.
- Leira R, Davalos A, Silva Y, et al. Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology 2004; 63: 461–67.
- Cordonnier C, Demchuk A, Ziai W, Anderson CS. Intracerebral haemorrhage: current approaches to acute management. Lancet 2018; 392: 1257–68.