title: Anticonvulsant prophylaxis and timing of seizures after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  There is no evidence that seizure prophylaxis is indicated after aneurysmal subarachnoid hemorrhage (SAH). This study examines prophylactic antiepileptic drug (AED) prescription and the occurrence of seizures within a single university-affiliated institution.
  
  
  METHODS
  The authors reviewed 95 SAH patient charts using standardized forms. Variables included prophylaxis duration, seizure incidence and timing, CT findings, AED adverse events, and 1-year patient follow-up.
  
  
  RESULTS
  Prehospital seizures occurred in 17.9% (17/95) of patients; another 7.4% (7/95) had a questionable prehospital seizure. In-hospital seizures occurred in 4.1% (4/95) of patients, a mean of 14.5 +/- 13.7 days from ictus; three of these four patients were receiving an AED at the time of seizure. Inpatient AED were prescribed to 99% of the cohort for a median of 12 (range 1 to 68) days. Approximately 8% of the cohort had posthospital discharge seizures; this included the patients who had prehospital or in-hospital seizures, 50% of whom were receiving AED therapy at the time of the seizure. Adverse effects occurred in 4. 1%; none were serious. The thickness of cisternal clot was associated with having a seizure; no other clinical predictors were identified. Having a seizure at any time did not adversely affect outcome.
  
  
  CONCLUSIONS
  In this SAH population, the majority of seizures happened before medical presentation. In-hospital seizures were rare and occurred more than 7 days postictus for patients receiving AED prophylaxis. The vast majority of putative clinical predictors did not help predict the occurrence of seizures; only the thickness of the cisternal clot was of value in predicting seizures. Patient selection for and the efficacy and timing of AED prophylaxis after SAH deserve prospective evaluation.
authors.affiliation: Department of Pharmacy Practice, Wayne State University College of Pharmacy, Allied Health Professions Health Center, Detroit, MI 48201, USA. d_rhoney@wayne.edu
authors.forename: D H
authors.initials: DH
authors.lastname: Rhoney
authors.forename: L B
authors.initials: LB
authors.lastname: Tipps
authors.forename: K R
authors.initials: KR
authors.lastname: Murry
authors.forename: M C
authors.initials: MC
authors.lastname: Basham
authors.forename: D B
authors.initials: DB
authors.lastname: Michael
authors.forename: W M
authors.initials: WM
authors.lastname: Coplin
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011292:Premedication; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants