Seizure prophylaxis after spontaneous intracerebral hemorrhage

JAMAJones FJS, Sanches PR, Smith JR, et al. | September 13, 2021

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This decision analysis simulating 4 common clinical scenarios revealed that short-term (7-day) early-seizure prophylaxis strategies dominated long-term therapy after spontaneous intracerebral hemorrhage (sICH). Consideration should be given to 2HELPS2B (a risk stratification tool) score use for guiding clinical decisions for initiation of short-term primary vs secondary early-seizure prophylaxis for all patients post-sICH.

  • There exists limited evidence regarding optimal seizure prophylaxis post-sICH.

  • This is an analysis of 4 antiseizure drug strategies (conservative, moderate, aggressive, and risk guided) in patients with sICH.

  • Quality-adjusted life-years were estimated for these strategies under the 4 common clinical scenarios simulated using models.

  • Under most of the scenarios, short-term strategies (conservative and risk guided) were preferred.

  • In most settings, a comparable or better performance of the risk-guided strategy was evident than alternative strategies.

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