Abstract Body: Background and Objectives: Early seizures are a common (10-25%) complication in the first week after acute intracerebral hemorrhage (ICH). However, prophylactic antiseizure medications have not been found to improve outcomes. We tested the hypothesis that prophylactic antiseizure medication would be associated with early seizures in patients at high risk for seizures after acute ICH and outcomes at follow-up.
Methods: We analyzed prospectively identified consecutive patients with lobar ICH at five sites in the US. We defined high risk for seizures as lobar location of the hematoma, and explored the addition of younger age, larger hematoma volume, and sex as a biological variable. We prospectively recorded the use of antiseizure medications as prophylactic or therapeutic, and identified the occurrence of early seizures clinically or on electroencephalography. At three months, we measured functional outcomes with the modified Rankin Scale and HRQoL in the domains of mobility, cognitive function, and satisfaction with social roles in T Scores (normal 50 +/- 10).
Results: There were 300 patients with lobar ICH. The mean age was 70 +/- 14 years, and 158 (53%) were female. Overall, 43 (14.3%) patients had an acute seizure. In patients who did not receive antiseizure prophylaxis, 34 of 157 (21.6%) had a seizure. Prophylactic antiseizure medication was associated with a reduced incidence of early seizures (OR 0.25, 95% CI 0.11 - 0.54, P = 0.0005). At three months, T Score of Cognitive Function HRQoL were 11.8 (95%CI 5.6 - 18, P=0.0003) points lower in patients who received prophylactic antiseizure medication, with similar results after stratification by early seizure. In multivariable models, prophylactic antiseizure medication was associated with reduced cognitive function HRQoL (P=0.0004) after correction for age, hematoma volume, seizure, and sex. Results for T Scores of satisfaction with social roles and activities HRQoL were similar to cognitive function HRQoL. T Scores of mobility HRQoL and the Rankin Scale were not different.
Discussion: In patients with lobar ICH, prophylactic antiseizure medication was associated with a reduced likelihood of an early seizure and reduced HRQoL in multiple domains. Precise patient selection could reduce the incidence of early seizures and minimize effects on HRQoL.

Note: This abstract is to be considered for the Robert G. Siekert New Investigator Award (Member ID: 100001645980).