Antiepileptic Drugs for Preventing Seizures in Patients with Chronic Subdural Hematoma

Chronic subdural hematoma (CSH) is an accumulation of blood within the intracranial subdural space. It is associated with minor traumatic events and affects mostly the elderly. CSH can be effectively treated surgically with good outcomes, although the recurrence rate is high. Epileptic seizures are one of the major complications associated with CSH, either in the pre or postoperative period. The incidence rate of new onset seizures after CSH diagnosis ranges between 3% and 23%. However, the benefit of using prophylactic antiepileptic drugs in these patients is controversial with significant variations in clinical practice. It ranges from routine to total absence of use in this clinical context. The best current evidence does not allow any firm conclusion on whether such prophylactic treatment is effective, that is if it prevents the development of epileptic seizures. Furthermore, these drugs are associated with important adverse events. A systematic literature review found no controlled randomized trials evaluating the risk/benefit of the prophylactic use of anticonvulsants for people with CSH and retrospective studies showing contradictory results. Moreover, these observational studies are outdated and do not evaluate new generation drugs. Herein, we discuss the evidence for the use of antiepileptic drugs for preventing seizures in patients with CSH, with a particular focus on the subgroup of people most likely to benefit (such as the elderly and alcohol abusers), as well as the possible safety advantages of the new antiepileptic drugs.