Anticonvulsants for preventing seizures in patients with chronic subdural haematoma

Ratilal BO, Costa J, Sampaio C

Summary

Anti-epileptic drugs for preventing seizures in patients with long-term subdural haematoma

Chronic subdural haematoma (CSH) is a serious condition in which blood collects under the thickest membrane that surrounds the brain, known as the dura mater. CSH is usually caused by minor head injuries in which a vein has torn, and this happens in particular in older patients and patients with other brain problems. A CSH may cause seizures which can be dangerous. Some doctors give patients anti-epileptic drugs such as phenytoin or phenobarbital to try to prevent seizures. However, most patients with CSH will not have seizures and anti-epileptic drugs can have serious side effects.

The review authors researched whether patients with a CSH who received anti-epileptic drugs had fewer seizures than those who did not. They searched the medical journal literature to find randomised controlled trials in which one group of patients received a treatment (anti-epileptic drugs, which could be given before or after surgery for the CSH) and was compared with a similar group which received a non-active or different treatment. The authors could find no randomised controlled trials. They did find other studies which were not as high quality evidence. These had conflicting results regarding the benefit of anti-epileptics.

The review authors conclude that better research needs to be done on this topic and, for now, there is no clear evidence to support the regular use of anti-epileptic drugs for patients with long-term subdural haematoma.