Antiseizure Medications Show No Significant Impact on Epilepsy Risk After Brain Abscess: JAMA

A new study published in the Journal of American Medical Association found that the use of antiseizure medications did not substantially alter the likelihood of epilepsy in patients with brain abscesses 90, 135, or 180 days after initiation.

A brain abscess, which is frequently caused by an infectious agent, is an enclosed region of pus inside the brain. Repeated unprovoked seizures, or epilepsy, are a typical side effect of brain abscesses. Given that brain abscess survivors frequently experience seizures and epilepsy, therapies that stop these conditions from developing should be found.

Clinical recommendations for the treatment of brain abscesses, including whether antiseizure drugs (ASMs) should be started to avoid epilepsy, were published by the European Society of Clinical Microbiology and Infectious Diseases. Thus, this study was set to determine whether starting ASMs is linked to a lower risk of epilepsy.

Utilizing US commercial insurance claims data from October 1, 2016, to June 30, 2022, this retrospective cohort study simulated a target trial and followed up with patients for 180 days. The International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes linked to an acute care visit were used to limit the research population to individuals with a diagnosis of brain abscess.

Only patients who had been enrolled for at least a year before and who were at least 18 years old at the time of the brain abscess were included. The period of statistical study was May through December of 2024. Levetiracetam, valproate, and phenytoin were the research ASMs that were first chosen. ASM initiation within a 45-day grace period was compared to no ASM initiation using a clone-censor-weight methodology.

The mean (SD) age of the 572 patients included was 61.5 (16.6) years, and 353 (61.7%) of them were men. Within the first 30 days, 83 (88.3%) of the patients in the therapy group started taking ASMs. During follow-up, 129 individuals (22.5%) experienced seizures.

The likelihood of epilepsy incidence at each follow-up time point did not change statistically significantly in terms of risk (RD at 90 days, -0.02% [95% CI, −4.9% to 4.8%]; RD at 135 days, 1.9% [95% CI, −5.0% to 8.5%]; RD at 180 days, 3.5% [95% CI, –4.4% to 10.8%]). Also, sensitivity analysis supported the main conclusions. Overall, the replicated trial did not find that starting ASMs was linked to a lower risk of epilepsy in this cohort study of brain abscess survivors.

Source:

Nielsen, V. M., Klompas, M., Manjourides, J., & Smith, L. H. (2025). Initiation of antiseizure medications in patients with brain abscess. JAMA Network Open, 8(8), e2524557. https://doi.org/10.1001/jamanetworkopen.2025.24557