  Seizures are common after intracerebral hemorrhage, occurring in 6 to 15% of
the patients, mostly in the first 72 hours. Their incidence reaches 30% when
subclinical or non-convulsive seizures are diagnosed by continuous
electroencephalogram. Several risk factors for seizures have been described
including cortical location of intracerebral hemorrhage, presence of
intraventricular hemorrhage, total hemorrhage volume, and history of alcohol
abuse. Seizures after intracerebral hemorrhage may theoretically be harmful as
they can lead to sudden blood pressure fluctuations, increase intracranial
pressure and neuronal injury due to increased metabolic demand. Some recent
studies suggest that acute symptomatic seizures (occurring within seven days of
stroke) are associated with worse functional outcome and increased risk of
death despite accounting for other known prognostic factors such as age and
baseline hemorrhage volume. However, the impact of seizures on prognosis is
still debated and it remains unclear if treating or preventing seizures might
lead to improved clinical outcome. Thus, the currently available scientific
evidence does not support the routine use of antiseizure medication as primary
prevention among patients with intracerebral hemorrhage. Only prospective
adequately powered randomized controlled trials will be able to answer whether
seizure prophylaxis in the acute or longer term settings is beneficial or not
in patients with intracerebral hemorrhage.
