What are the benefits and risks associated with the use of prophylactic anticonvulsants after aSAH?
Although retrospective studies have not demonstrated a benefit for use of prophylactic anticonvulsants after aSAH, any purported benefit of routine anticonvulsant use in aSAH must be tempered by a consideration of the potential risks of such use. In 1 large single-institution study in which anticonvulsants were used routinely, adverse drug effects were seen in 23% of patients.276 Another single-center retrospective study found that the use of prophylactic phenytoin was independently associated with a worse cognitive outcome at 3 months after aSAH.291 Data pooled from trials of the impact of other therapies also suggest a worse outcome in those treated with anticonvulsants, but use of anticonvulsants was also associated with vasospasm, DCI, and fever, which suggests that there may have been bias in who was treated with antiepileptic drugs.292