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Seizures and Choice of Antiepileptic Drugs Following Subarachnoid Hemorrhage: A Review

  • Sherif Hanafy Mahmoud (a1) and Jenna Buxton (a1)

Seizures are important complications following a subarachnoid hemorrhage (SAH). The evidence for the use of antiepileptic drugs (AEDs) in treatment and prevention of those seizures is conflicting. The purpose of this review is to provide an up-to-date evidence summary of the incidence and outcomes of seizures following an SAH as well as the use of different AEDs post-SAH in order to evaluate the need for seizure prophylaxis, the choice of AEDs, and their dosing considerations in SAH patients. A literature search of PubMed, Medline, Embase, and the Cochrane Library was performed. A total of 37 studies were reviewed, mostly observational. Definitions of seizures in temporal relation to initial hemorrhage were variable. Similarly, the rates of seizures varied in the literature, ranging from 0 to 31%. Given the reported adverse outcomes associated with AED usage, seizure prophylaxis is not warranted. Levetiracetam appears to be better tolerated than phenytoin in SAH patients, though further research is needed. Higher initial dosing of levetiracetam might be required due to its enhanced clearance in SAH patients. In conclusion, there is a lack of quality evidence to definitively recommend the use of one AED over another. Further prospective research comparing the use of different AEDs in patients with an SAH is needed.

Crises convulsives et choix de médicaments antiépileptiques suite à une hémorragie sous-arachnoïdienne : une revue. Les crises convulsives constituent des complications importantes après une hémorragie sous-arachnoïdienne (HSA). Les données en faveur de l’utilisation de médicaments antiépileptiques (MAE) dans le traitement et la prévention de ces crises sont contradictoires. Le but de cette revue est de présenter une mise-à-jour sommaire des données sur l’incidence et l’issue des crises suite à une HSA ainsi que sur l’utilisation de différents MAE post HSA afin d’évaluer la nécessité d’une prophylaxie et le choix et le dosage des MAE chez les patients atteints d’une HSA. Nous avons effectué une recherche de la littérature indexée dans PubMed, Medline, Embase et la Bibliothèque Cochrane. Nous avons revu 37 études, surtout des études d’observation. Les définitions des crises en relation temporelle avec l’hémorragie initiale étaient variables. De même, les taux de crises convulsives variaient dans la littérature, allant de 0 à 31%. Étant donné les résultats défavorables rapportés avec l’utilisation de MAE, la prophylaxie des crises convulsives n’est pas justifiée. Bien que des recherches supplémentaires soient nécessaires, le lévétiracétam semble être mieux toléré que la phénytoïne chez les patients atteints d’une HSA. Une dose supérieure initiale de lévétiracétam peut être requise à cause de sa clairance augmentée chez ces patients. Il existe un manque de données de qualité en faveur d’une recommandation de l’utilisation d’un MAE plutôt que d’un autre. De nouvelles études prospectives comparant l’utilisation de différents MAE chez les patients atteints d’une HSA devront être réalisées.

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Corresponding author
Correspondence to: Sherif Hanafy Mahmoud, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3-228 Edmonton Clinic Health Academy, Edmonton, Alberta, Canada, T6G 1C9. Email:
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Canadian Journal of Neurological Sciences
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