Seizures prophylaxis in Chronic Subdural Hematoma

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.

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. https://doi.org/10.1002/14651858.CD004893.pub3

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-