Dilemma of seizure prophylaxis in sub-arachnoid haemorrhage

There is around 10% risk of developing seizures in post subarachnoid hemorrhage (SAH) period. This is considered to be linked to decreased oxygenation of brain due to increase in intra-cranial pressure obviating use of anti-epileptic drugs (AED) as a prophylactic measure. This review was done to study the effect and changes of blood brain barrier permeability in subarachnoid hemorrhage with regard to the present knowledge available and how it could be utilized to open arenas for future research for the rationalization of therapy for such patients. There is no consensus till date on the etiopathogenesis due to which no established guidelines are present for the management of such patients. It is safer to approach the patient on a case by case basis and assess whether to give prophylaxis or not based on the risk of development of seizures and adverse event profile of drugs. Also, there is a need to conduct prospective studies in this arena so as to get some meaningful interpretations which could be of some use to the future therapeutic guidelines.