NEW YORK (Reuters Health) – Patients given phenytoin after an intracerebral hemorrhage (ICH) have more fevers while hospitalized and worse functional outcomes at 3 months, according to investigators at Northwestern University in Chicago.

By contrast, seizure prophylaxis with levetiracetam appears to have no effect on outcomes following ICH, the researchers report in the December Stroke.

Seizures are more common with hemorrhagic stroke than with ischemic stroke, author Dr. Andrew M. Naidech and colleagues note. Nevertheless, information is lacking regarding the effectiveness and side effects of antiepileptic drug use after ICH.

The research team prospectively recorded data from medical records of 98 consecutive patients with ICH, excluding those with ICH due to trauma or structural lesions.

Twelve patients were treated with levetiracetam, 22 with phenytoin, 6 were treated with both, and 58 did not receive either drug.

Seven patients had clinical seizures, including 5 that occurred on the same day as the ICH. Neither phenytoin nor levetiracetam reduced the risk of seizure.

Patients treated with phenytoin, however, had an increased risk of poor outcome (odds ratio 9.8, p = 0.02) compared to patients not treated with this anticonvulsant. Specifically, phenytoin was associated with more days with fever during the first 13 days (p = 0.03), worse National Institutes of Health Stroke Scale score at day 14 (23 vs 11 among patients not treated with phenytoin), and worse modified Rankin Scale score at days 14, 28, and 3 months.

Levetiracetam treatment was not related to seizures, complications, or outcomes, the report indicates.

The researchers note that their findings “confirmed some previous findings that clinical seizures usually occurred within 24 hours, were uncommon, and not associated with outcomes, implying that universal prophylaxis is unlikely to benefit most patients.”

On the other hand, they admit, their study was not a randomized trial.

In conclusion, the authors write, “Future research might clarify protocols for the effective use and reporting of electroencephalographic monitoring, target specific populations at high risk for seizures after ICH (e.g., lobar hemorrhage with depressed mental status), and examine protocols to minimize antiepileptic drug exposure in patients unlikely to benefit from therapy.”

Reference:
Stroke 2009;40:3810-3815.