Prophylactic Antiepileptic Drugs in Nontraumatic Intracerebral Hemorrhage: A Network Meta-Analysis.
Natan Lucca Lima, Marcos Henrique da Silva Mezzari, Josete Mazon et al.
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In 30 seconds
This systematic review and Bayesian network meta-analysis compared prophylactic antiepileptic drugs (AEDs) with one another or control in adults with nontraumatic intracerebral hemorrhage (ICH). It included 17 studies—4 randomized trials and 13 observational studies—with 6597 patients. No AED significantly reduced early seizures or improved functional outcomes compared with placebo. Valproate had the highest ranking probabilities for preventing early seizures (SUCRA = 0.8330) and improving functional outcomes (SUCRA = 0.7938), but certainty across comparisons was low to very low.
Key findings
- No AED significantly reduced early seizures or improved functional outcomes compared with placebo.
- Valproate ranked highest for early seizure prevention (SUCRA = 0.8330) and functional outcomes (SUCRA = 0.7938).
- Valproate ranked highest for overall safety (SUCRA = 0.8085); levetiracetam ranked highest for serious adverse events (SUCRA = 0.7935).
- Eslicarbazepine was associated with increased mortality; valproate had the most favorable mortality ranking (SUCRA = 0.7705).
Why it matters
Seizure prophylaxis after nontraumatic ICH remains uncertain, and this analysis does not establish a significant benefit for any AED on early seizures or functional outcomes. Its comparative rankings may help identify candidates for further study, but low-to-very-low certainty means they should not be interpreted as proof of superiority or as evidence supporting routine prophylaxis.
What to keep in mind
The evidence combined randomized and observational studies, and certainty across comparisons ranged from low to very low.