Antiepileptic drugs for the prevention of post-stroke seizures: results of a cochrane systematic review

Abstract

Objectives: Post-stroke seizures are an important clinical problem, and they may be associated with higher mortality and poor outcome. The effects of antiepileptic drugs for the primary and secondary prevention of post-stroke seizures remain unclear. We aimed to assess the effects of antiepileptic drugs for the primary and secondary prevention of post-stroke seizures. Methods: We searched the Specialized Registers of the Cochrane Epilepsy Group and the Cochrane Stroke Group, the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library and MEDLINE (OVID). We also checked the reference lists of articles retrieved from these searches. We selected randomized and quasi-randomized controlled trials in which patients were assigned to treatment or control group (placebo or no drug). Review authors independently screened all the titles, abstracts, and keywords of publications identified by the searches to assess their eligibility, and both review authors assessed their suitability for inclusion according to pre-specified selection criteria. Results: We included only one randomized controlled trial that fulfilled the study inclusion criteria of comparison of the effects of an antiepileptic drug with placebo (or no drug) for the primary or secondary prevention of post-stroke seizures. This was a prospective randomized, double-blind, placebo-controlled trial comparing Valproic Acid with placebo for primary prevention of seizures in 72 adult patients (over 18 years) with spontaneous non-aneurysmal, non-traumatic intracerebral hemorrhage. In this trial, no statistically significant difference in outcome (seizure occurrence at one year) was demonstrated between groups. We excluded three randomized controlled trials that compared the effects of several different antiepileptic drugs for the secondary prevention of post-stroke seizures. The first study was performed in adults over 60 years old with a mixture of diagnoses including stroke (comparing Carbamazepine, Lamotrigine and Gabapentin); the second study was performed in children and younger adults (patients included over the age of 4 years) with a mixture of diagnoses including stroke (comparing Carbamazepine, Oxcarbazepine, Lamotrigine, Gabapentin and Topiramate); and the third study was performed in stroke patients only (comparing Carbamazepine and Lamotrigine). Conclusions There is currently insufficient evidence to support the routine use of antiepileptic drugs for the primary or secondary prevention of post-stroke seizures. Further well-conducted, large-scaled randomized controlled trials are needed to explore which antiepileptic drug(s) may be the most suitable, at what dosage, and for what duration, for preventing post-stroke seizures.