LAUSR

Introduction/Hypothesis: Literature suggests that it is common practice to use prophylactic antiepileptic drugs (AEDs) in adults with intracranial hemorrhages (ICH) in an attempt to prevent early seizures, though this practice is not supported by most guidelines. Practice trends have been shifting towards using levetiracetam for this purpose due to improved safety profiles when compared to first-generation AEDs. The primary purpose of this study was to determine if levetiracetam is effective in preventing early seizures in patients with an ICH, and also to examine the effects of prophylactic levetiracetam on functional outcomes. Methods: This was a retrospective, multicenter, cohort chart review of adults with an ICH between October 1, 2017 and September 30, 2018. Patients were included if they had a radiographically confirmed ICH of any subtype, location, and etiology. The patients were grouped into a treatment group which consisted of patients who received prophylactic levetiracetam and a control group who did not receive prophylactic AEDs. The primary outcome of the study was the incidence of early seizures, defined as a seizure occurring within 7 days of the ICH. Secondary outcomes included inhospital mortality, hospital length of stay, and functional status as measured by the Modified Rankin Scale (mRS) and discharge disposition. Regression analysis was performed to evaluate the risk factors for early seizures. Results: A total of 1,697 patients were assessed for inclusion into the study, and 211 patients were included. Baseline characteristics were significantly different in several criteria. Overall, 17 patients (8%) experienced an early seizure, with 12 (11%) occurring in the levetiracetam group and 5 (5%) occurring in the control group (p=0.073). All seizure events started no later than day four of admission. The use of prophylactic levetiracetam was not associated with a significant difference in any secondary study outcome. The occurrence of an early seizure was also not identified as a significant risk factor for worsened functional outcomes. Conclusions: Prophylactic levetiracetam did not result in either a significant reduction in early seizures, nor improved functional outcomes in the studied population. Further prospective studies are warranted to validate the results of this study.