Epilepsy CurrentsBe a PEACH and Hand Me That Levetiracetam: Seizure Prophylaxis for Spontaneous Intracerebral Hemorrhage

Dive into the intriguing findings from the PEACH trial on prophylactic levetiracetam for seizure prevention in intracerebral haemorrhage patients.

The PEACH trial aimed to test prophylactic levetiracetam for seizure prevention in acute intracerebral haemorrhage (ICH) patients. Early seizures within seven days of stroke onset occur in almost 30% of patients. However, current guidelines lack strategies to manage this issue.

Despite being prematurely stopped, the trial showed promise. In this double-blind, randomised, placebo-controlled trial, 50 patients received either levetiracetam or a placebo. Clinical or electrographic seizures were seen in 16% of levetiracetam patients and 43% of placebo patients within 72 hours.

Interestingly, these seizures were only electrographic. Adverse events included headaches and pain, but no treatment-related deaths were reported. The findings suggest levetiracetam may prevent acute seizures in ICH patients, but larger studies are needed.

Acute seizures can lead to increased morbidity and mortality. The trial found fewer seizures within 72 hours of study inclusion in the levetiracetam group. This is promising, but more research is required.

This study opens avenues for further investigation. It raises questions about early detection of interictal epileptiform activity and the need for prophylactic levetiracetam. It also underscores the need to understand which factors influence seizure risk, and if acute anti-seizure prophylaxis reduces the risks of morbidity, mortality, and chronic epilepsy.

In conclusion, the PEACH trial indicates prophylactic levetiracetam’s potential efficacy for seizure prevention. Despite the study’s limitations, the results are promising and call for larger clinical trials.