Seizure Management in Aneurysmal Subarachnoid Hemorrhage

Aneurysmal subarachnoid haemorrhage (aSAH) represents a life-threatening bleed into the space surrounding the brain, often complicated by the emergence of seizures. Such events range from early convulsive fits at the moment of aneurysm rupture to delayed or non-convulsive seizure activity detected only by electroencephalography. Seizures in this setting may exacerbate intracranial pressure, promote re-bleeding and hinder neurological assessment for delayed cerebral ischaemia. Current management encompasses risk stratification, judicious use of prophylactic antiseizure medication, targeted continuous electroencephalographic monitoring in high-risk patients and rapid conversion to longer-term therapy if recurrent or non-convulsive seizures are identified. Selection of agents now favours drugs with lower interaction profiles, such as levetiracetam, over traditional enzyme-inducing agents. Debate persists over the optimal duration of prophylaxis, balancing potential neurotoxicity against the risk of secondary brain injury. Multidisciplinary protocols that integrate neurosurgical, neurocritical and neurophysiological expertise are increasingly advocated to streamline detection, treatment and minimisation of secondary complications, thereby improving functional outcomes and reducing mortality worldwide.

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Seizure Management in Aneurysmal Subarachnoid Hemorrhage publication trend

The graph below shows the total number of articles in seizure management in aneurysmal subarachnoid hemorrhage across all publications each year (not limited to Nature Index journals).

Technical terms

Aneurysmal subarachnoid haemorrhage: Bleeding into the subarachnoid space caused by rupture of a cerebral aneurysm.

Prophylactic antiseizure medication: Administration of anticonvulsant drugs in the absence of clinical seizures to prevent seizure onset.

Continuous electroencephalography (EEG): Ongoing recording of brain electrical activity to detect overt or subtle seizure patterns.

Non-convulsive status epilepticus: Prolonged seizure activity on EEG without prominent motor manifestations.

Delayed cerebral ischaemia: Secondary brain injury occurring days after the initial haemorrhage due to cerebral vasospasm or microthrombosis.

References

1. Seizure prophylaxis in the neuroscience intensive care unit. Journal of Intensive Care (2018).
2. Impact of Seizures and Status Epilepticus on Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage. Neurocritical Care (2022).
3. Non-Convulsive Status Epilepticus in Aneurysmal Subarachnoid Hemorrhage: A Prognostic Parameter. Brain Sciences (2023).