Effectiveness of prophylactic administration of new-generation antiepileptic drugs for prevention of seizures following surgical clipping in patients with aneurysmal subarachnoid hemorrhage

BACKGROUND: The efficacy of prophylactic administration of antiepileptic drugs (AEDs) for patients with aneurysmal subarachnoid hemorrhage (SAH) remains controversial, and further research is required to ascertain the efficacy of new-generation AEDs in preventing the seizures that may occur after aneurysmal SAH. This study aimed to clarify the efficacy of prophylactic administration of new-generation AEDs in preventing the development of seizures following surgical clipping for aneurysmal SAH. METHODS: A retrospective study was conducted on 89 patients diagnosed with SAH between 2021 and 2024 who underwent surgical clipping for ruptured intracranial aneurysms. In the present study, seizures were not defined based on findings of electroencephalogram, but defined as apparent convulsion. The administration of AEDs was started immediately after the surgery, and how to use the AEDs was determined by each physician, including the selection of the type of AEDs, dose escalation, and treatment duration. We investigated patient characteristics, including the development of seizures, prophylactic administration of AEDs, and clinical outcomes. RESULTS: Of the 89 patients, seizures were observed in 8 (9.0%) patients. Patients diagnosed with seizures were significantly older and had worse prognoses. Perampanel was administered prophylactically to a significantly larger number of patients without seizures. However, there were no significant differences in the administration of lacosamide or levetiracetam between patients with and without seizures, respectively. In contrast, no substantial differences were observed in patient characteristics, except for seizure occurrence and lacosamide utilization between those who were and were not administered perampanel. CONCLUSIONS: Prophylactic administration of perampanel or adequate escalation of the dose could contribute to a decrease in the incidence of seizures developing after surgical clipping for aneurysmal SAH.