Administration of prophylactic levetiracetam in patients with intracerebral hemorrhage: A systematic review and meta-analysis

Levetiracetam (LEV) is not frequently recommended as a preventative medication for seizures after intracerebral hemorrhage (ICH). Although there are differing opinions among clinicians, current recommendations do not support its use. We aim to assess the effectiveness of LEV in seizure prophylaxis in patients with ICH. We systematically searched PUBMED, SCOPUS, and other databases. Clinical trials and observational studies that enrolled patients in Spontaneous ICH and provided independent data on LEV were included. The pooled proportions of reported findings were determined using the random-effects model and forest plots were created. We identified six studies with a total of 1,166 patients for the analyses of primary and secondary outcomes. There were no significant differences in the total frequency of seizures between LEV treatment and placebo (OR=0.52; 95% CI-0.21–1.31; P=0.17) and also LEV treatment did not lower the death rate. (OR=1.14, 95% CI-0.57–2.26, P- 0.71). In half of the investigations (n=3), the poor clinical outcomes were defined using the mRS (i.e. score >3). The results showed that taking the placebo resulted in worse outcomes (OR-6.24, 95% CI-3.97-9.81, P.00001). Overall, there were no appreciable differences between LEV and placebo regarding the change in NIHSS of less than 25 (MID, 1.98; 95%CI, 0.15–4.12; P=0.07). However, these two trials showed a significant amount of heterogeneity (I2=83%). LEV did not significantly reduce mortality and seizure occurrences on average than those on other anti-epileptic medications. Our study is the first to analyze the efficacy of this newer-generation anti-epileptic drug for seizure prophylaxis in patients with ICH.