(New recommendation) Seizures and Antiseizure Drugs The frequency of clinical seizures early (within 1 week) after ICH is as high as 16%, with the majority occurring at or near Cortical involvement of ICH is the most impor- tant risk factor for early seizures.158 160 In a large single-center study, prophylactic antiseizure drugs significantly reduced the number of clinical seizures after lobar ICH.161 Prospective and population-based studies, however, have shown no asso- ciation between clinical seizures and neurological outcome or Studies of continuous electroencephalography (EEG) report electrographic seizures in 28% to 31% of select cohorts of ICH patients, despite most having received prophylactic The clinical impact of subclini- cal seizures detected on EEG is unclear. Most studies suggest that prophylactic antiseizure drugs (primarily phenytoin) are associated with increased death and disability in ICH,165 167 although a recent study found no association between antiseizure drugs and out- come in those who survived beyond 5 days after ICH, which highlights the possible influence of confounding in A small randomized trial of 1-month prophylactic treatment with valproic acid showed no reduc- tion in incident seizures over 1-year follow-up (19.5% in the treatment group, 22.2% in the placebo group; P=0.8).168 Prophylactic anticonvulsant medication has thus not been demonstrated to be beneficial. Clinical seizures or electrographic seizures in patients with a change in mental status should be treated with antisei- zure drugs. Continuous EEG monitoring should be considered in ICH patients with depressed mental status that is dispropor- tionate to the degree of brain injury. 