AEDs after ICH

Has the routine use of antiepileptic drugs (AEDs) in intracerebral hemorrhage (ICH) become a habit too difficult to break? Adherents to evidence-based medicine must surely have a conniption in light of this continuing practice. The guidelines have remained clear over the years: Do not use antiseizure medications in ICH unless there has been a seizure. Yet prophylactic AED use after acute ICH remains widespread in the United States. This is brought to our attention in the current issue of Neurology®. Naidech et al.¹ report on the patterns of AED use in ICH over 5 years across several academic medical centers in Chicago. Placing the study period into its historical context, it was conducted after the publication of the 2010 American Heart Association/American Stroke Association (AHA/ASA) guidelines on the management of ICH, the first to recommend against this practice.² The authors show a widespread disregard for this expert recommendation. In fact, over the 5-year study period, the use of AEDs almost doubled, and towards the end of the study period, in 2012, 40% of all patients were given AEDs. The study was done in academic centers, commonly believed to uphold the standards of evidence-based management more strictly than others. During this study period, the use of phenytoin fell dramatically, while that of levetiracetam increased. The authors submit, as a possible explanation for the increased use of AEDs, the ease of use of levetiracetam over phenytoin, with fewer drug interactions and adverse events, despite the guideline recommendations.