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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.
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.
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- © 2016 American Academy of Neurology
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