Overview
Nontraumatic intracerebral hemorrhage (ICH) is a common and devastating neurological emergency. Practice heterogeneity exists regarding the use of prophylactic antiseizure medications (ASM) in hospitalized patients with acute nontraumatic ICH 1.Diagnosis
No specific diagnostic criteria or grading scales are mentioned in the provided abstracts.Management
The use of prophylactic antiseizure medications (ASM) in patients with acute nontraumatic ICH and no history of clinical or electrographic seizures is controversial 1.
Meta-analyses showed no significant impact of prophylactic ASM on early or late seizures or mortality 1.
Prophylactic ASM use was associated with increased adverse events and a higher relative risk of poor functional outcomes at 90 days 1.
No significant positive or negative effect of phenytoin/fosphenytoin compared to other ASMs was detected 1.Key Recommendations
The use of prophylactic antiseizure medications (ASM) in patients with acute nontraumatic intracerebral hemorrhage (ICH) who have not experienced clinical or electrographic seizures is not recommended due to increased adverse events and potential for worse functional outcomes, with no clear benefit in seizure prevention or mortality 1. (Evidence: Moderate)
If ASM prophylaxis is considered, levetiracetam or phenytoin/fosphenytoin are not demonstrably superior to each other 1. (Evidence: Moderate)
If ASM prophylaxis is used, a duration of greater than 7 days versus 7 days or less did not show a significant difference in outcomes 1. (Evidence: Moderate)References
1 Frontera JA, Rayi A, Tesoro E, Gilmore EJ, Johnson EL, Olson D et al.. Guidelines for Seizure Prophylaxis in Patients Hospitalized with Nontraumatic Intracerebral Hemorrhage: A Clinical Practice Guideline for Health Care Professionals from the Neurocritical Care Society. Neurocritical care 2025. link