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July 25, 2000; 55 (2) Article

Anticonvulsant prophylaxis and timing of seizures after aneurysmal subarachnoid hemorrhage

D.H. Rhoney, L.B. Tipps, K.R. Murry, M.C. Basham, D.B. Michael, W.M. Coplin
First published July 25, 2000, DOI: https://doi.org/10.1212/WNL.55.2.258
D.H. Rhoney
From the Department of Pharmacy Practice (Dr. Rhoney)Wayne State University College of Pharmacy; Allied Health Professions Department of Pharmacy Services (Drs. Tipps and Murry), Detroit Receiving Hospital/University Health Center; and the Departments of Radiology (Dr. Basham), Neurology (Dr. Coplin), and Neurological Surgery (Drs. Michael and Coplin), Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit Medical Center, MI.
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L.B. Tipps
From the Department of Pharmacy Practice (Dr. Rhoney)Wayne State University College of Pharmacy; Allied Health Professions Department of Pharmacy Services (Drs. Tipps and Murry), Detroit Receiving Hospital/University Health Center; and the Departments of Radiology (Dr. Basham), Neurology (Dr. Coplin), and Neurological Surgery (Drs. Michael and Coplin), Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit Medical Center, MI.
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K.R. Murry
From the Department of Pharmacy Practice (Dr. Rhoney)Wayne State University College of Pharmacy; Allied Health Professions Department of Pharmacy Services (Drs. Tipps and Murry), Detroit Receiving Hospital/University Health Center; and the Departments of Radiology (Dr. Basham), Neurology (Dr. Coplin), and Neurological Surgery (Drs. Michael and Coplin), Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit Medical Center, MI.
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M.C. Basham
From the Department of Pharmacy Practice (Dr. Rhoney)Wayne State University College of Pharmacy; Allied Health Professions Department of Pharmacy Services (Drs. Tipps and Murry), Detroit Receiving Hospital/University Health Center; and the Departments of Radiology (Dr. Basham), Neurology (Dr. Coplin), and Neurological Surgery (Drs. Michael and Coplin), Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit Medical Center, MI.
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D.B. Michael
From the Department of Pharmacy Practice (Dr. Rhoney)Wayne State University College of Pharmacy; Allied Health Professions Department of Pharmacy Services (Drs. Tipps and Murry), Detroit Receiving Hospital/University Health Center; and the Departments of Radiology (Dr. Basham), Neurology (Dr. Coplin), and Neurological Surgery (Drs. Michael and Coplin), Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit Medical Center, MI.
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W.M. Coplin
From the Department of Pharmacy Practice (Dr. Rhoney)Wayne State University College of Pharmacy; Allied Health Professions Department of Pharmacy Services (Drs. Tipps and Murry), Detroit Receiving Hospital/University Health Center; and the Departments of Radiology (Dr. Basham), Neurology (Dr. Coplin), and Neurological Surgery (Drs. Michael and Coplin), Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit Medical Center, MI.
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Citation
Anticonvulsant prophylaxis and timing of seizures after aneurysmal subarachnoid hemorrhage
D.H. Rhoney, L.B. Tipps, K.R. Murry, M.C. Basham, D.B. Michael, W.M. Coplin
Neurology Jul 2000, 55 (2) 258-265; DOI: 10.1212/WNL.55.2.258

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Abstract

Objective: There is no evidence that seizure prophylaxis is indicated after aneurysmal subarachnoid hemorrhage (SAH). This study examines prophylactic antiepileptic drug (AED) prescription and the occurrence of seizures within a single university-affiliated institution.

Methods: The authors reviewed 95 SAH patient charts using standardized forms. Variables included prophylaxis duration, seizure incidence and timing, CT findings, AED adverse events, and 1-year patient follow-up.

Results: Prehospital seizures occurred in 17.9% (17/95) of patients; another 7.4% (7/95) had a questionable prehospital seizure. In-hospital seizures occurred in 4.1% (4/95) of patients, a mean of 14.5 ± 13.7 days from ictus; three of these four patients were receiving an AED at the time of seizure. Inpatient AED were prescribed to 99% of the cohort for a median of 12 (range 1 to 68) days. Approximately 8% of the cohort had posthospital discharge seizures; this included the patients who had prehospital or in-hospital seizures, 50% of whom were receiving AED therapy at the time of the seizure. Adverse effects occurred in 4.1%; none were serious. The thickness of cisternal clot was associated with having a seizure; no other clinical predictors were identified. Having a seizure at any time did not adversely affect outcome.

Conclusions: In this SAH population, the majority of seizures happened before medical presentation. In-hospital seizures were rare and occurred more than 7 days postictus for patients receiving AED prophylaxis. The vast majority of putative clinical predictors did not help predict the occurrence of seizures; only the thickness of the cisternal clot was of value in predicting seizures. Patient selection for and the efficacy and timing of AED prophylaxis after SAH deserve prospective evaluation.

  • Received October 18, 1999.
  • Accepted in final form April 6, 2000.
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