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The following is a summary of “Antiseizure Medications in Poststroke Seizures A Systematic Review and Network Meta-Analysis,” published in the January 2025 issue of Neurology by Misra et al. 

Researchers conducted a retrospective study to evaluate the outcomes of antiseizure medications (ASMs) in poststroke seizures (PSSs). 

They searched databases for studies on patients with PSS using ASMs. Outcomes included seizure recurrence, adverse events (AEs), discontinuation, and mortality. Bias was assessed using the Cochrane risk of bias tool and risk of bias in non-randomized studies of interventions tool. A network meta-analysis was performed with levetiracetam as the reference, and evidence certainty was assessed using the grading of recommendations assessment, development, and evaluation methodology. 

The results showed that 15 studies (3 randomized, 12 nonrandomized, N = 18,676 patients (121 early and 18,547 late seizures), 60% male, mean age 69 years) compared 13 ASMs. Seizure recurrence was 24.8%. Phenytoin had higher seizure recurrences (OR 7.3, 95% CI 3.7–14.5) and more AEs (OR 5.2, 95% CI 1.2–22.9) compared with levetiracetam.  

Carbamazepine (OR 1.8, 95% CI 1.5–2.2) and phenytoin (OR 1.9, 95% CI 1.4–2.8) had high drug discontinuation rates. Valproic acid (OR 4.7, 95% CI 3.6–6.3) and phenytoin (OR 8.3, 95% CI 5.7–11.9) were associated with higher mortality. Eslicarbazepine, lacosamide, and levetiracetam had the fewest seizure recurrences. Lamotrigine had the fewest AEs and drug discontinuations, while lamotrigine and levetiracetam had low mortality rates. 

Investigators concluded that levetiracetam and lamotrigine were potentially safe and tolerable ASMs for PSSs. However, high seizure recurrence rates and biases required cautious interpretation of these findings. 

Source: neurology.org/doi/10.1212/WNL.0000000000210231