Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
J Neurol Sci. 2021 Oct 15;429:117624. doi: 10.1016/j.jns.2021.117624. Epub 2021 Aug 24.
Seizure activity following spontaneous intracerebral hemorrhage (sICH) can worsen patients' comorbidity. However, data regarding whether seizure prophylaxis for sICH is associated with patients' poor functional outcome is inconclusive. We performed a systematic review and meta-analysis to assess the relationship between phenytoin prophylaxis and poor functional outcome after sICH.
We conducted our search on PubMed, Scopus, and EMBASE databases as of October 30, 2020 for studies that included information on seizure prophylaxis and functional outcome in patients with sICH. Primary outcome was poor functional outcome at the longest follow-up in patients receiving seizure prophylaxis. The secondary outcome was poor functional outcome at 90 days follow-up. We conducted random effects meta-analysis and moderator analyses to detect sources of heterogeneity for our outcomes.
We included eleven studies in the final analysis with a total of 4268 patients. A moderator analysis further showed prospective studies had lower heterogeneity. We did not find an association between seizure prophylaxis and poor functional outcome at time of longest follow-up (OR 1.2, 95%CI 0.9-1.6, p-value = 0.22, I = 61%), nor at 90-day follow-up (OR 1.4, 95%CI 0.8-2.4, p-value = 0.24, I = 78%).
Seizure prophylaxis following sICH was not associated with worse functional outcomes at longest follow-up or at 90 days. Neither levetiracetam nor phenytoin was associated with outcome in our exploratory meta-regression, though there is a trend towards better outcomes in populations where there was a higher percentage of patients who received levetiracetam. More randomized trials are needed to confirm this observation.
自发性脑出血（sICH）后癫痫发作活动可能会加重患者的合并症。然而，关于 sICH 是否进行预防性抗癫痫治疗与患者不良功能结局之间的关系，目前的数据尚无定论。我们进行了一项系统评价和荟萃分析，以评估 sICH 后预防性应用苯妥英钠与不良功能结局之间的关系。
我们在 2020 年 10 月 30 日之前，在 PubMed、Scopus 和 EMBASE 数据库中进行了检索，纳入了关于 sICH 患者中抗癫痫预防和功能结局的研究。主要结局为接受抗癫痫预防治疗的患者在最长随访时间时的不良功能结局。次要结局为 90 天随访时的不良功能结局。我们进行了随机效应荟萃分析和亚组分析，以检测我们结局的异质性来源。
最终分析纳入了 11 项研究，共 4268 例患者。一项亚组分析进一步显示前瞻性研究的异质性较低。我们未发现抗癫痫预防与最长随访时间时（OR 1.2，95%CI 0.9-1.6，p 值=0.22，I²=61%）或 90 天随访时（OR 1.4，95%CI 0.8-2.4，p 值=0.24，I²=78%）的不良功能结局之间存在关联。
sICH 后预防性应用抗癫痫药物与最长随访时间或 90 天的不良功能结局无关。在我们的探索性荟萃回归中，左乙拉西坦和苯妥英钠均与结局无关，尽管在接受左乙拉西坦治疗的患者比例较高的人群中，结局有改善的趋势。需要更多的随机试验来证实这一观察结果。
