Seizures prophylaxis in Chronic Subdural Hematoma

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

Primary Category
Secondary Category


  • 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.

Further Reading

  • Ratilal, B. O., Pappamikail, L., Costa, J., & Sampaio, C. (2013). Anticonvulsants for preventing seizures in patients with chronic subdural haematoma. The Cochrane database of systematic reviews, 2013(6), CD004893.


  • 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.
  • 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.
  • 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.
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Tooba Kashif MBBS, MD

MBBS, MD, Researcher

Junaid Kalia MD

Written by

Junaid Kalia MD

Founder NeuroCare.AI, Practicing Neurologist, sub-specialized in the field of Neurocritical Care, Stroke & Epilepsy

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