Bottom line: Antiepileptic drugs (AEDs) are used in the setting of traumatic brain injury and intracerebral hemorrhage. Prophylactic AEDs for these indications are recommended by Brain Trauma Foundation and American Heart Association, respectively, although there is no strong evidence for benefit in the setting of intracerebral hemorrhage.
Summary: For traumatic brain injury, there is evidence for up to 1 week use to prevent early post-traumatic seizures. Use with patients with aneurysmal subarachnoid hemorrhage and ichemic stroke is controversial with no evidence of benefit from prospective randomized trials. Other conditions for which there is demonstrated risk of seizures for which there is no evidence of efficacy of prophylactic AEDs include brain tumors, cerebral venous and sinus thrombosis and herpes simplex encephalitis.
Liu KC, Bhardwaj A. Use of Prophylactic Anticonvulsants in Neurologic Critical Care: A Critical Appraisal. Neurocritical care. 2007; 7(2): 175-184.
Repost of August 24, 2010