Antiepileptic drugs for the primary and secondary prevention of seizures after stroke

Kwan J, Wood E

Published Online:

January 20, 2010

Seizures (epileptic attacks) after stroke are a major clinical problem. It is unclear whether antiepileptic drugs are effective in preventing seizures after stroke. This Cochrane review did not find any high quality clinical trials that have assessed whether antiepileptic drugs are more effective than placebo in preventing seizures after stroke. Currently, therefore, there is not enough evidence to justify the routine use of antiepileptic drugs to prevent seizures after stroke. Further research is needed for this important clinical problem.

Abstract (click to read)

Background:

Seizures after stroke are an important clinical problem, and they may be associated with poor outcome. The effects of antiepileptic drugs for the primary and secondary prevention of seizures after stroke remain unclear.

Objectives:

We aimed to assess the effects of antiepileptic drugs for the primary and secondary prevention of seizures after stroke.

Search strategy:

We searched the Specialised Registers of the Cochrane Epilepsy Group and the Cochrane Stroke Group (2 July 2009), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 2, 2009), and MEDLINE (1950 to June, week 4, 2009). We also checked the reference lists of articles retrieved from these searches.

Selection criteria:

Randomised and quasi-randomised controlled trials in which patients were assigned to treatment or control group (placebo or no drug).

Data collection and analysis:

Both 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. No study was included, hence no data analysis was performed.

Main results:

We did not find any randomised controlled trials that have compared the effects of antiepileptic drugs with placebo (or no drug) for the primary or secondary prevention of seizures after stroke. We did, however, find three randomised controlled trials that have assessed the effects of several different antiepileptic drugs for the secondary prevention of post-stroke seizures. The first study was performed in older adults (mean age 72 years) with a mixture of diagnoses including stroke (comparing carbamazepine, lamotrigine and gabapentin); the second study was performed in children and younger adults (mean age 38 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).

Authors' conclusions:

Currently, there is insufficient evidence to support the routine use of antiepileptic drugs for the primary or secondary prevention of seizures after stroke. Further well-conducted research is needed for this important clinical problem.

This record should be cited as:

Kwan J, Wood E. Antiepileptic drugs for the primary and secondary prevention of seizures after stroke. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD005398. DOI: 10.1002/14651858.CD005398.pub2

Assessed as up to date:

November 4, 2009

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Primary Review Group:

Epilepsy Group

Health topics:

Neurology > Epilepsy > Seizures associated with stroke

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Independent high-quality evidence for health care decision making

Antiepileptic drugs for the primary and secondary prevention of seizures after stroke

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