Medication use for epilepsy prevention after stroke or traumatic brain injury

Epilepsy is a common condition that requires treatment with antiepileptic medications and may occur after stroke or traumatic brain injury. It is possible to use various medications to prevent occurrence of epileptical seizures after stroke or traumatic brain injury.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202410 Registration no: SBU 2023/1183

Question

What systematic reviews have been published regarding the use of medications to prevent epilepsy after stroke or traumatic brain injury?

Method

A systematic literature search was performed using the following databases: MedLine (Ovid) and Scopus.

Two authors independently assessed the abstracts of all identified studies.

Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

One relevant systematic review with moderate risk of bias was identified [1]. The results and conclusions are presented in Table 1. In 5 relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [2] [3] [4] [5] [6].

Table 1 Systematic review with moderate risk of bias.
Included study Population, Intervention, Control Outcome and Results
Chang et al., Antiepileptic drugs for the primary and secondary prevention of seizures after stroke (Review), 2022. [1]
2 randomised double-blind studies (n=72; n=856) Population:
Participants with either ischaemic or haemorrhagic stroke

Intervention:
Use of antiepileptic drugs (AEDs) such as diazepam and valproic acid.

Control:
Placebo		 Primary prophylaxis of post-stroke seizure with AEDs (2 studies, n=856):
RR=0.65 (95% CI, 0.34 to 1.26)
Authors' conclusion:
There is insufficient evidence to support the routine use of AEDs on the primary and secondary prevention of seizures after stroke. Further well-conducted studies are warranted for this important clinical problem.

References

  1. Chang RS, Leung WC, Vassallo M, Sykes L, Battersby Wood E, Kwan J. Antiepileptic drugs for the primary and secondary prevention of seizures after stroke. Cochrane Database Syst Rev. 2022;2(2):CD005398. Available from: https://doi.org/10.1002/14651858.CD005398.pub4.
  2. Mota Telles JP, Rocha RB, Cenci GI, Nager GB, Silva GD, Figueiredo EG. Prophylactic antiseizure drugs for spontaneous intracerebral hemorrhage: An updated systematic review and meta-analysis. Int J Stroke. 2023;18(7):773-82. Available from: https://doi.org/10.1177/17474930221140071.
  3. Acton EK, Khazaal O, Willis AW, Gelfand MA, Hennessy S, Selim MH, Kasner SE. Statins for the Prevention of Post-Stroke Seizure and Epilepsy Development: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis. 2021;30(10):106024. Available from: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106024.
  4. Guo Y, Zhu LH, Zhao K, Guo XM, Yang MF. Statin use for the prevention of seizure and epilepsy in the patients at risk: A systematic review and meta-analysis of cohort studies. Epilepsy Res. 2021;174:106652. Available from: https://doi.org/10.1016/j.eplepsyres.2021.106652.
  5. Bakr A, Belli A. A systematic review of levetiracetam versus phenytoin in the prevention of late post-traumatic seizures and survey of UK neurosurgical prescribing practice of antiepileptic medication in acute traumatic brain injury. Br J Neurosurg. 2018;32(3):237-44. Available from: https://doi.org/10.1080/02688697.2018.1464118.
  6. Zafar SN, Khan AA, Ghauri AA, Shamim MS. Phenytoin versus Leviteracetam for seizure prophylaxis after brain injury - a meta analysis. BMC Neurol. 2012;12:30. Available from: https://doi.org/10.1186/1471-2377-12-30.

Appendix 1 Search strategies

Medline via OvidSP 5 February 2024

Title: Epilepsy poststroke or post traumatic brain injury
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp= Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf.; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other.; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. exp Epilepsy, Post-Traumatic/ or ((post-traumatic or posttraumatic or postapoplectic or poststroke) adj2 (epilep* or seizure* or Convulsion*)).ab,bt,kf,ti. 2324
2. exp Brain Injuries, Traumatic/ or (((acquired or traumatic) adj2 (brain injur* or brain damage* or cerebral damage* or cerebral injur* or cranial injur* or brainstem injur* or cerebral contusion* or craniocerebral injur* or head injur*)) or cerebral trauma* or cranial trauma* or craniocerebral trauma* or head trauma or concussion* or brain trauma* or TBI).ab,bt,kf,ti. 84 600
3. exp Stroke/ or (Stroke or Strokes or Cerebrovascular Accident* or CVA or CVAs or Vascular Accident* or acute cerebrovascular lesion* or apoplexia or apoplexy or "acute focal cerebral vasculopathy" or brain accident* or brain attack* or "blood flow disturbance" or brain insult* or ischaemic attack* or ischemic attack* or cerebral insult* or "cerebral vascular insufficiency" or cerebrovascular arrest* or cerebrovascular failure* or "cerebrovascular insufficiency" or cerebrovascular insult* or ischaemic cerebral attack* or ischaemic seizure* or ischemic cerebral attack* or ischemic seizure*).ab,bt,kf,ti. 388 264
Intervention:
4. exp Anticonvulsants/ or (antiseizure* or antiepileptic or Anticonvul*).ab,bt,kf,ti. 174 997
5. (exp Epilepsy/ or exp Status Epilepticus/ or (Epileptic* or epilepsy).ab,bt,kf,ti.) and (exp Hydroxymethylglutaryl-CoA Reductase Inhibitors/ or exp Anticoagulants/ or exp Primary Prevention/ or exp Secondary Prevention/ or (medicat* or drug* or treat* or HMG-CoA or statin or statins or Hydroxymethylglutaryl CoA or Anticoagulant* or antithrombin* or thrombin inhibitor* or prevent* or prophyla* or protect*).ab,bt,kf,ti.) 83 573
Study types: systematic reviews and meta-analysis
6. ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/)) 468 530
Combined sets:
7. 1 OR 2 OR 3 467 951
8. 4 OR 5 39 457
9. 7 AND 8 6793
10. 6 AND 9 205
Final result
11. 10 205

Scopus via scopus.com 5 February 2024

Title: Epilepsy poststroke or post traumatic brain injury
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields
W/n = Within. Proximity operator retrieving terms within n words from each other.; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words.; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range.; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TITLE-ABS-KEY ( ( post-traumatic OR posttraumatic OR postapoplectic OR poststroke ) W/2 ( epilep* OR seizure* OR convulsion* ) ) 2713
2. TITLE-ABS-KEY ( ( acquired OR traumatic ) W/2 ( "brain injur*" OR "brain damage*" OR "cerebral damage*" OR "cerebral injur*" OR "cranial injur*" OR "brainstem injur*" OR "cerebral contusion*" OR "craniocerebral injur*" OR "head injur*" ) ) 80 008
3. TITLE-ABS-KEY ( stroke OR strokes OR "cerebrovascular accident" OR "cerebrovascular accidents" OR cva OR cvas OR "vascular accident" OR "vascular accidents" OR "acute cerebrovascular lesion*" OR apoplexia OR apoplexy OR "acute focal cerebral vasculopathy" OR "brain accident*" OR "brain attack*" OR "blood flow disturbance*" OR "brain insult*" OR "ischaemic attack*" OR "ischemic attack*" OR "cerebral insult*" OR "cerebral vascular insufficiency" OR "cerebrovascular arrest*" OR "cerebrovascular failure*" OR "cerebrovascular insufficiency" OR "cerebrovascular insult*" OR "ischaemic cerebral attack*" OR "ischaemic seizure*" OR "ischemic cerebral attack*" OR "ischemic seizure*" ) 643 717
Intervention:
4. TITLE-ABS-KEY (antiseizure* or antiepileptic* OR anticonvul*) 136 450
5. TITLE-ABS-KEY (Epilep* W/4 and (medicat* or drug* or treat* or HMG-CoA or statin or statins or Hydroxymethylglutaryl CoA or Anticoagulant* or antithrombin* or thrombin inhibitor* or prevent* or prophyla* or protect*)) 47 025
Study types: systematic reviews and meta-analysis
6. TITLE-ABS-KEY ((systematic W/2 review ) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”)) 687 529
Combined sets:
7. 1 OR 2 OR 3 715 915
8. 4 OR 5 159 706
9. 7 AND 8 6797
10. 6 AND 9 301
Final result
11. 10 301
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