The effect of prophylactic antiepileptic medications in aneurysmal subarachnoid hemorrhage patients: A retrospective review

Andrew M Smith; Paul R Clark; Kenneth A Winter; Zachary P Smalley; Sean M Duke; Michael Dedwylder; Chad W Washington

doi:10.1016/j.clineuro.2021.106633

The effect of prophylactic antiepileptic medications in aneurysmal subarachnoid hemorrhage patients: A retrospective review

Clin Neurol Neurosurg. 2021 Apr 2:205:106633. doi: 10.1016/j.clineuro.2021.106633. Online ahead of print.

Authors

Andrew M Smith¹, Paul R Clark², Kenneth A Winter³, Zachary P Smalley⁴, Sean M Duke⁵, Michael Dedwylder⁶, Chad W Washington⁷

Affiliations

¹ Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA. Electronic address: amsmith3@umc.edu.
² Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA. Electronic address: prclark@umc.edu.
³ Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA. Electronic address: kwinter@umc.edu.
⁴ Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA. Electronic address: zsmalley@umc.edu.
⁵ Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA. Electronic address: sean.duke@uhhospitals.org.
⁶ Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA. Electronic address: mdedwylder@health.fau.edu.
⁷ Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA. Electronic address: cwashington4@umc.edu.

PMID: 33887506
DOI: 10.1016/j.clineuro.2021.106633

Abstract

Objective: The current literary evidence suggests but does not heavily endorse the use of prophylactic antiepileptic drugs (AEDs) after aneurysmal subarachnoid hemorrhage. Literature continues to emerge suggesting not only a lack of efficacy but associated poor outcomes. This study is a retrospective review comparing seizure incidence in aneurysmal subarachnoid patients between those given prophylactic AEDs and those not.

Methods: With IRB approval, a retrospective chart review was performed on all aneurysmal subarachnoid patients from 2012 to 2019 at the University of Mississippi Medical center. Univariate and Multivariate analysis was performed using SAS. Primary outcome was seizure incidence between groups. Factors associated with seizure and poor outcome were also investigated.

Results: 348 patients were identified: 120 in the AED group, and 228 patients in the non-AED group. There was no significant difference in mean age, gender, ethnicity, HH scores, treatment modality, or mean aneurysm size. The AED group had a higher history of prior aneurysmal rupture (6.7% vs. 1.3%, p = 0.01) and associated intracranial hemorrhage (22.5% vs. 10.5%, p = 0.0004). There was no significant difference in seizure incidence between the two groups (8.3% vs. 4.8%, p = 0.24). On multivariate analysis, aneurysm clipping compared to coiling (OR 3.8, p = 0.012) and delayed cerebral ischemia (OR 2.77, p = 0.023) were associated with seizures. DCI (OR 8.34), HH grade, Age (OR 1.07), Seizure (8.34), and AED use (1.7) were significantly associated with poor outcome.

Conclusion: This retrospective review adds to the evidence that prophylactic AED use in aneurysmal subarachnoid hemorrhage patients has not been proven to improve seizure rates and may result in worse patient outcomes.

Keywords: Aneurysmal subarachnoid hemorrhage; Antiepileptic drugs; Outcome; Seizure.