Levetiracetam found effective for acute seizure prevention in intracerebral hemorrhage: LANCET

A new investigation found that acute seizures in intracerebral hemorrhage can be prevented by Levetiracetam. The study was published in the journal 'The LANCET Neurology.' 

There is a 30% incidence of early seizures after intracerebral hemorrhage when subclinical seizures are diagnosed by EEG, and this can cause hematoma expansion and worsening neurological outcomes. Presently there are no guidelines on prophylactic antiseizure treatment. Hence researchers conducted a double-blind, randomized, placebo-controlled, phase 3 trial to assess if prophylactic levetiracetam would reduce the risk of acute seizures in patients with intracerebral hemorrhage. 

The phase 3 PEACH trial was conducted at three stroke units in France by including patients who were aged 18 years or older and presented with a non-traumatic intracerebral hemorrhage within 24 h after onset. The participants were randomly assigned with a web-based system and stratified by center and National Institutes of Health Stroke Scale (NIHSS) score at baseline, to intravenous levetiracetam 500 mg every 12 h or matching placebo. The treatment was carried out for 6 weeks and continuous EEG was started within 24 h after inclusion and recorded over 48 h. The primary endpoint was the occurrence of at least one clinical seizure within 72 h of inclusion or at least one electrographic seizure recorded on continuous EEG, analyzed in the modified intention-to-treat population, which comprised all patients who were randomly assigned to treatment and who had a continuous EEG performed. 

Results: 

• 50 patients with mild-to-moderate severity intracerebral hemorrhage were included between June 1, 2017, and April 14, 2020.
• 24 were assigned to levetiracetam and 26 to placebo.
• During the first 72 h, a clinical or electrographic seizure was observed in three (16%) of 19 patients in the levetiracetam group versus ten (43%) of 23 patients in the placebo group.
• All seizures in the first 72 h were electrographic seizures only.
• No difference in depression or anxiety reporting was observed between the groups at 1 month or 3 months.
• Depression was recorded in three (13%) patients who received levetiracetam versus four (15%) patients who received placebo, and anxiety was reported for two (8%) patients versus one (4%) patient.
• The most common treatment-emergent adverse events in the levetiracetam group versus the placebo group were headache, pain, and falls.
• The most frequent serious adverse events were neurological deterioration due to the intracerebral hemorrhage and severe pneumonia.
• No treatment-related death was reported in either group. 

Thus, the researchers concluded that for preventing acute seizures in intracerebral hemorrhage, Levetiracetam might be an effective solution. 

For further reading, click here: 10.1016/S1474-4422(22)00235-6

Peter-Derex L, Philippeau F, Garnier P, et al. Safety and efficacy of prophylactic levetiracetam for prevention of epileptic seizures in the acute phase of intracerebral haemorrhage (PEACH): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2022;21(9):781-791.