ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurocritical and Neurohospitalist Care
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1580539
Exploratory Study on the Potential Benefits of Prophylactic Levetiracetam After Acute Spontaneous Intracerebral Hemorrhage
Provisionally accepted
Marc A. Babi1*
Irina Lishen1Barbara Pierre Louis2Katelyn Woodbury1Anthony Kennedy1
Fouad Abuzeid1
Amre Nouh1- 1Cleveland Clinic Florida, Weston, United States
- 2College of Medicine, Florida State University, Tallahassee, Florida, United States
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Importance: Current guidelines recommend against the routine use of seizure prophylaxis in acute spontaneous Intracerebral hemorrhage (sICH). Objective: The goal of this study is to evaluate if the use of prophylactic levetiracetam resulted in reduced incidence of seizure, morbidity and length of stay, compared to patients who did not receive prophylactic levetiracetam. Design: This retrospective chart review includes patients admitted with ICH at Cleveland Clinic Florida Martin Health from January 2019 to October 2022. Main Outcome and Measures: primary outcome was incidence of seizure during the first seven days of admission. Secondary outcomes include intensive care unit and hospital length of stay measured in days. Results A total of 160 patients were included in this study, 93 in the levetiracetam group. The primary outcome of clinical seizure incidence within 7 days of ICH diagnosis was observed in 5 patients, all of which were in the prophylactic levetiracetam group, though this did not reach statistical significance (5% vs. 0%; p=0.075). In adjusted analysis, levetiracetam showed a non-significant protective trend (OR 0.71,. The median length of hospital stay, and ICU stay were both longer in the prophylactic levetiracetam group (5 days vs. 3 days; p<0.001 and 2 days vs. 1 day; p=0.001, respectively). However in adjusted analyses these differences were not statistically significant. Conclusion and Relevance: The routine use of seizure prophylaxis with levetiracetam did not result in a significant reduction in early seizure incidence, and in unadjusted analyses, the prophylaxis group had longer ICU and hospital stays. However, these differences were not significant after adjustment for key clinical confounders. Randomized controlled trials need to be conducted to determine whether seizure prophylaxis with levetiracetam contributes to worse outcomes.
Keywords: neurocritical care, Seizures, Critical Care, intracranial hemorrhage, intracerebral hemorrhage, Intensive Care Unit, levetiracetam
Received: 20 Feb 2025; Accepted: 29 Jul 2025.
Copyright: © 2025 Babi, Lishen, Louis, Woodbury, Kennedy, Abuzeid and Nouh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Marc A. Babi, Cleveland Clinic Florida, Weston, United States
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