Department of Emergency Medicine, University of Maryland School of Medicine, 22 South Greene Street, Suite T3N45, Baltimore MD 21201, USA; The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Suite T3N45, Baltimore MD 21201, USA; Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, 22 South Greene Street, Suite T3N45, Baltimore MD 21201, USA.
Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, 22 South Greene Street, Suite T3N45, Baltimore MD 21201, USA.
Seizure. 2021 Apr;87:46-55. doi: 10.1016/j.seizure.2021.02.029. Epub 2021 Mar 1.
Spontaneous intracerebral haemorrhage (ICH) is associated with high mortality and high morbidity, including seizures. Seizure prophylaxis is "not recommended" by the American Stroke Association, but practice variation still exists due to inconclusive data. We performed a meta-analysis to assess the current relevant literature to determine the efficacy of seizure prophylaxis following ICH.
We performed searches of PubMed, Scopus, and Embase up to September 15, 2020. We included observational and randomized controlled studies reporting seizure prophylaxis and occurrence in adults with ICH. Outcomes were seizures, as defined by the authors, within 14 days of ICH and at the longest point of follow-up. We used random-effects models to estimate the odds ratios (ORs) for seizure prophylaxis and outcomes. The PROSPERO registration was CRD42019140493.
We included 8 studies (2852 patients) in our analysis. The mean (± standard deviation) age of the pooled patients was 65 (±4) years; 39 % (± 5%) were female. Seizure prophylaxis did not prevent seizures at the longest follow-up time (OR 0.708, 95 % CI 0.438-1.143, p = 0.158, I2 = 34 %). This result was confirmed in subgroup analyses using categorical variables and in meta-regressions using continuous variables. Additionally, seizure prophylaxis was not associated with preventing early seizures, defined as < 14 days of ICH (OR 0.66, 95 % CI 0.21-2.08, p = 0.48, I2 = 35 %).
Seizure prophylaxis following ICH was not associated with seizure prevention in adults. Most included studies were observational. Further randomized controlled trials examining the efficacy of seizure prophylaxis in high-risk patients and different types of antiepileptic drugs are needed.
自发性脑出血（ICH）死亡率和发病率高，包括癫痫发作。美国卒中协会“不建议”进行癫痫预防，但由于数据不确定，实践仍存在差异。我们进行了一项荟萃分析，以评估当前相关文献，以确定 ICH 后癫痫预防的疗效。
我们对PubMed、Scopus 和 Embase 进行了搜索，截至 2020 年 9 月 15 日。我们纳入了报告成人 ICH 中癫痫预防和发作的观察性和随机对照研究。结局是ICH 后 14 天内和最长随访时间内的作者定义的癫痫发作。我们使用随机效应模型估计癫痫预防和结局的优势比（OR）。PROSPERO 注册为 CRD42019140493。
我们的分析纳入了 8 项研究（2852 例患者）。汇总患者的平均（±标准差）年龄为 65（±4）岁；39%（±5%）为女性。癫痫预防并不能预防最长随访时间的癫痫发作（OR 0.708，95%CI 0.438-1.143，p=0.158，I2=34%）。这一结果在使用分类变量进行亚组分析和使用连续变量进行元回归分析时得到了证实。此外，癫痫预防与预防早期癫痫发作（ICH 后<14 天定义为癫痫发作）无关（OR 0.66，95%CI 0.21-2.08，p=0.48，I2=35%）。
ICH 后癫痫预防与成人癫痫发作无关。大多数纳入的研究都是观察性的。需要进一步的随机对照试验来研究高危患者和不同类型抗癫痫药物的癫痫预防效果。
