Background: The risk factors for seizures in patients with intracerebral hemorrhage (ICH) stroke and the effect of prophylactic anticonvulsant are not well understood. Limited studies investigated the risk of seizure after discontinuing prophylactic antiepileptic drugs in patients with ICH. This study aimed to investigate the role of valproic acid (VA) for seizure prevention and to access the risk of seizure after anticonvulsant withdrawal in patients with spontaneous ICH.
Methods: Between 2013 and 2015, 177 patients with ICH were enrolled in this 3-year retrospective study. Seizure was classified as early seizure (first seizure within 1 week of ICH), delayed seizure (first seizure after 1 week), and late seizure (any seizure after 1 week). Binary logistic regression was used to evaluate the relationship between baseline clinical factors and late seizure between study VA was prescribed or discontinued based on the decision of the physician in charge.
Results: Seizures occurred in 24 patients, including early seizure in 6.78% (12/177) of the patients, delayed seizure in 7.27% (12/165) of the patients without early seizure, and late seizure in 9.60% (17/177) of the patients. Most seizures occurred within the first year. Binary logistic regression analysis showed ICH with cortex involvement as the independent risk factor for seizures. VA did not decrease the risk of seizure. Patients with ICH with cortical involvement using prophylactic anticonvulsant for longer than 3 months did not decrease risk of seizure (Odds ratio 1.86, 95% CI: 0.43-8.05).
Conclusion: Spontaneous ICH with cortex involvement is the risk factor for seizure. Most seizures occurred within 1 year after stroke onset over a 3-year follow up. Discontinuation Prophylactic antiepileptic drug within 3 months in patients do not increase risk of seizure. VA cannot prevent seizure in patients with ICH.