Some studies have reported no impact on outcome,276,278 whereas others found seizures to be independently associated with worse outcome.275 Two recent large, retrospective, single-institution studies of pa- tients with aSAH found that nonconvulsive status epilepticus is a very strong predictor of a poor outcome.285,286 Although high-quality evidence for routine anticonvulsant use in aSAH is lacking, short-term prophylactic antiepileptic therapy is still commonly used in patients with aSAH,274,276,278 based on the argument that seizures in acutely ill patients with aSAH could lead to additional injury or rebleeding from an unse- cured aneurysm. Evidence from a few relatively small non- randomized studies of craniotomy patients supports this position,281,282,287 but the efficacy of routine use of anticon- vulsants in patients with aSAH managed with microsurgical techniques remains unproven.288 290 Any purported benefit of routine anticonvulsant use in aSAH must be tempered by a consideration of the potential risks of such use. In 1 large single-institution study in which anticonvulsants were used routinely, adverse drug effects were seen in 23% of patients.276 Another single-center retro- spective study found that the use of prophylactic phenytoin was independently associated with a worse cognitive out- come at 3 months after aSAH.291 Data pooled from trials of the impact of other therapies also suggest a worse outcome in those treated with anticonvulsants, but use of anticonvulsants was also associated with vasospasm, DCI, and fever, which suggests that there may have been bias in who was treated with antiepileptic drugs.292 Although retrospective studies have not demonstrated a benefit for use of prophylactic anticonvulsants after aSAH,273,288 the studies were small and hampered by limitations (eg, anticonvulsant levels were not Management of Seizures Associated With aSAH: Recommendations 1. The use of prophylactic anticonvulsants may be considered in the immediate posthemorrhagic pe- riod (Class IIb; Level of Evidence B). 2. 