Seizures after Subarachnoid Hemorrhage and Clinical Use of Anti-seizure Medication

Seizures are observed in 6–30% of patients after subarachnoid hemorrhage (SAH) and are associated with poor functional outcomes; however, the use of prophylactic anti-seizure medications (ASM) for SAH is controversial. Between 2015 and 2020, 190 patients with SAH were treated at our hospital. We retrospectively surveyed the current ASM prescription practices, incidence of seizures, and risk factors for seizures in patients after SAH. The clinical variables were compared based on their association with the occurrence of seizures. Seizures occurred in 40 patients (21.1%) and were correlated with a higher WFNS grade, clipping, intracranial hematoma, middle cerebral aneurysm, and delayed cerebral ischemia. The timing of seizures was as follows: onset seizure (OS) in 5 patients, early seizures (ES) in 13 patients, ES and delayed seizures (LS) in 9 patients, and only LS in 13 patients. Twelve patients (51.9 %) with OS or ES developed LS, and prophylactic ASM was administered to 47 (25.4 %) patients. Levetiracetam was the most widely used ASM, and no patient discontinued treatment owing to ASM-induced side effects within one month of onset. For patients with SAH who are judged to be at a high risk of seizures, the prophylactic use of new-generation ASM seemed acceptable. Additionally, patients had a relatively high rate of symptomatic epilepsy if they experienced seizures, even in the acute phase.