Effects of New-Generation Antiepileptic Drug Prophylaxis on Delayed Neurovascular Events After Aneurysmal Subarachnoid Hemorrhage

Neuroelectric disruptions such as seizures and cortical spreading depolarization may contribute to the development of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH). However, effects of antiepileptic drug prophylaxis on outcomes remain controversial in SAH. The author...

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Bibliographic Details
Published in:Translational stroke research 2023-12, Vol.14 (6), p.899-909
Main Authors: Suzuki, Hidenori, Miura, Yoichi, Yasuda, Ryuta, Yago, Tetsushi, Mizutani, Hisashi, Ichikawa, Tomonori, Miyazaki, Takahiro, Kitano, Yotaro, Nishikawa, Hirofumi, Kawakita, Fumihiro, Fujimoto, Masashi, Toma, Naoki
Format: Article
Language:English
Subjects:
Aneurysms
Angioplasty
Anticonvulsants - therapeutic use
Biomedical and Life Sciences
Biomedicine
Brain Ischemia - drug therapy
Brain Ischemia - etiology
Brain Ischemia - prevention & control
Cardiology
Cerebral Infarction - complications
Cohort Studies
Convulsions & seizures
Drugs
Hemorrhage
Hospitals
Humans
Hydrocephalus
Ischemia
Levetiracetam - therapeutic use
Medical imaging
Metabolism
Microcirculation
Neurology
Neurosciences
Neurosurgery
Patients
Prospective Studies
Retrospective Studies
Seizures
Stroke
Subarachnoid Hemorrhage - complications
Subarachnoid Hemorrhage - diagnostic imaging
Subarachnoid Hemorrhage - drug therapy
Vascular Surgery
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Summary:Neuroelectric disruptions such as seizures and cortical spreading depolarization may contribute to the development of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH). However, effects of antiepileptic drug prophylaxis on outcomes remain controversial in SAH. The authors investigated if prophylactic administration of new-generation antiepileptic drugs levetiracetam and perampanel was beneficial against delayed neurovascular events after SAH. This was a retrospective single-center cohort study of 121 consecutive SAH patients including 56 patients of admission World Federation of Neurological Surgeons grades IV − V who underwent aneurysmal obliteration within 72 h post-SAH from 2013 to 2021. Prophylactic antiepileptic drugs differed depending on the study terms: none (2013 − 2015), levetiracetam for patients at high risks of seizures (2016 − 2019), and perampanel for all patients (2020 − 2021). The 3rd term had the lowest occurrence of delayed cerebral microinfarction on diffusion-weighted magnetic resonance imaging, which was related to less development of DCI. Other outcome measures were similar among the 3 terms including incidences of angiographic vasospasm, computed tomography-detectable delayed cerebral infarction, seizures, and 3-month good outcomes (modified Rankin Scale 0 − 2). The present study suggests that prophylactic administration of levetiracetam and perampanel was not associated with worse outcomes and that perampanel may have the potential to reduce DCI by preventing microcirculatory disturbances after SAH. Further studies are warranted to investigate anti-DCI effects of a selective α-amino-3-hydroxy-5-methyl-4-isoxazole propionate receptor antagonist perampanel in SAH patients in a large-scale prospective study.
ISSN:1868-4483
1868-601X
DOI:10.1007/s12975-022-01101-9