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Is there evidence to support the use of antiepileptic drugs for the primary and secondary prevention of seizures after stroke?

Sykes L, Wood E, Kwan J
Published Online: 
25 January 2014

Background

Seizures (epileptic attacks) after stroke are a major clinical problem. It is unclear whether antiepileptic drugs are effective in preventing seizures after stroke in adults. This review searched in August 2013 for high quality evidence to help clarify this problem. We found only one high quality clinical trial that looked at whether antiepileptic drugs may be more effective than placebo in preventing seizures after stroke.

Study Characteristics

The only study that was included in this review was Gilad 2011. This was a prospective randomised, double-blind, placebo controlled trial studying the efficacy of valproic acid versus placebo in the primary prevention of seizure in 72 adults (over 18 years of age) with spontaneous non-aneurysmal, non-traumatic intracerebral haemorrhage. Patients were randomly allocated to either the treatment or the placebo group with active treatment lasting one month; the primary outcome was seizure occurrence at one year. People with very early seizures (within 24 hours of onset of haemorrhage) were excluded from the study. Seizure was diagnosed on the basis of eye-witness evidence from staff, relatives or other eye witnesses.

Quality Of The Evidence

There does not appear to be bias in Gilad 2011, on the basis of the information available within the study.

Key Results

Gilad 2011 did not show a statistically significant benefit when comparing valproic acid with placebo for the primary prevention of seizures after spontaneous non-aneurysmal, non-traumatic intracerebral haemorrhage. Currently, therefore, there is not enough evidence to justify the routine use of antiepileptic drugs to prevent seizures after stroke (evidence current to 08/2013). Further research is needed for this important clinical problem.

This record should be cited as: 
Sykes L, Wood E, Kwan J. Antiepileptic drugs for the primary and secondary prevention of seizures after stroke. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD005398. DOI: 10.1002/14651858.CD005398.pub3
Assessed as up to date: 
12 August 2013