Seizures prophylaxis in Chronic Subdural Hematoma

Primary Category

Epilepsy

P-Category

Secondary Category

S-Category

Authors:

Tooba Kashif MBBS, MD,
Junaid Kalia MD

Introduction

Chronic subdural hematoma is the chronic accumulation of blood in the subdural space. It is usually common in elderly patients, and traumatic injury could lead to Subdural hematoma.

Anti-seizures medications (ASM) are sometimes used prophylactically in CSDH, but no current guidelines are available for ASM therapy.

✨

Prophylaxis NOT treatment of seizures is discussed for Chronic Subdural Hematoma

Prophylaxis is NOT recommended!!!

Incidence of Seizures

A systematic review of literature for patients with SDH concludes that the incidence of early and late post-traumatic seizures are lower in Chronic Subdural hematoma (cSDH; 5.3% vs. 10%) as compared with Acute sub-Dural hematoma. (aSDH: 28% vs 43%).

Risk Factors for seizures:

Alcohol abuse

Changes in mental status

Previous stroke

The density of hematoma on CT (acuteness)

Current Evidence-based guidelines:

The benefits of using ASM are controversial in CSDH, with variations in clinical practice.

No current guidelines are available for prophylactic treatment with ASM in CSDH for the prevention of the development of epilepsy.

Another systematic review by Nachiappan et al showed that No significant reduction of seizures was associated with prophylactic use of the ASM in CSDH.

Bibliography

Branco, P. M., Ratilal, B. O., Costa, J., & Sampaio, C. (2017). Antiepileptic Drugs for Preventing Seizures in Patients with Chronic Subdural Hematoma. Current pharmaceutical design, 23(42), 6442–6445. https://doi.org/10.2174/1381612823666171024144318

Won, S. Y., Konczalla, J., Dubinski, D., Cattani, A., Cuca, C., Seifert, V., Rosenow, F., Strzelczyk, A., & Freiman, T. M. (2017). A systematic review of epileptic seizures in adults with subdural haematomas. Seizure, 45, 28–35. https://doi.org/10.1016/j.seizure.2016.11.017

Nachiappan, D. S., & Garg, K. (2021). Role of prophylactic antiepileptic drugs in chronic subdural hematoma-a systematic review and meta-analysis. Neurosurgical review, 44(4), 2069–2077. https://doi.org/10.1007/s10143-020-01388-

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