Importance Limited evidence is available concerning optimal seizure prophylaxis after spontaneous intracerebral hemorrhage (sICH). Objective To evaluate which of 4 seizure prophylaxis strategies provides the greatest net benefit for patients with sICH. Design, Setting, and Participants This decision analysis used models to simulate the following 4 common scenarios: (1) a 60-year-old man with low risk of early (≤7 days after stroke) (10%) and late (3.6% or 9.8%) seizures and average risk of short- (9%) and long-term (30%) adverse drug reaction (ADR); (2) an 80-year-old woman with low risk of early (10%) and late (3.6% or 9.8%) seizures and high short- (24%) and long-term (80%) ADR risks; (3) a 55-year-old man with high risk of early (19%) and late (34.8% or 46.2%) seizures and low short- (9%) and long-term (30%) ADR risks; and (4) a 45-year-old woman with high risk of early (19%) and late (34.8% or 46.2%) seizures and high short- (18%) and long-term (60%) ADR risks. Interventions The following 4 antiseizure drug strategies were included: (1) conservative, consisting of short-term (7-day) secondary early-seizure prophylaxis with long-term therapy after late seizure; (2) moderate, consisting of long-term secondary early-seizure prophylaxis or late-seizure therapy; (3) aggressive, consisting of long-term primary prophylaxis; and (4) risk guided, consisting of short-term secondary early-seizure prophylaxis among low-risk patients (2HELPS2B score, 0), short-term primary prophylaxis among patients at higher risk (2HELPS2B score, ≥1), and long-term secondary therapy for late seizure. Main Outcomes and Measures Quality-adjusted life-years (QALYs). Results For scenario 1, the risk-guided strategy (8.13 QALYs) was preferred over the conservative (8.08 QALYs), moderate (8.07 QALYs), and aggressive (7.88 QALYs) strategies. For scenario 2, the conservative strategy (2.18 QALYs) was preferred over the risk-guided (2.17 QALYs), moderate (2.09 QALYs), and aggressive (1.15 QALYs) strategies. For scenario 3, the aggressive strategy (9.21 QALYs) was preferred over the risk-guided (8.98 QALYs), moderate (8.93 QALYs), and conservative (8.77 QALYs) strategies. For scenario 4, the risk-guided strategy (11.53 QALYs) was preferred over the conservative (11.23 QALYs), moderate (10.93 QALYs), and aggressive (8.08 QALYs) strategies. Sensitivity analyses suggested that short-term strategies (conservative and risk guided) are preferred under most scenarios, and the risk-guided strategy performs comparably to or better than alternative strategies in most settings. Conclusions and Relevance This decision analytical model suggests that short-term (7-day) prophylaxis dominates longer-term therapy after sICH. Use of the 2HELPS2B score to guide clinical decisions for initiation of short-term primary vs secondary early-seizure prophylaxis should be considered for all patients after sICH.

中文翻译：

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自发性脑出血后的癫痫预防。

重要性 关于自发性脑出血 (sICH) 后最佳癫痫预防的可用证据有限。目的 评估 4 种癫痫预防策略中的哪一种为 sICH 患者提供最大的净收益。设计、设置和参与者 该决策分析使用模型模拟以下 4 种常见情况：(1) 一名 60 岁男性，早期（卒中后≤7 天）（10%）和晚期（3.6%）风险低或 9.8%) 癫痫发作和短期 (9%) 和长期 (30%) 药物不良反应 (ADR) 的平均风险；(2) 一名 80 岁女性，早期 (10%) 和晚期 (3.6% 或 9.8%) 癫痫发作风险低，短期 (24%) 和长期 (80%) ADR 风险高；(3) 一名 55 岁男性，早期 (19%) 和晚期 (34.8% 或 46.2%) 癫痫发作风险高，短期 (9%) 和长期 (30%) ADR 风险低；(4) 一名 45 岁女性，具有较高的早期 (19%) 和晚期 (34.8% 或 46.2%) 癫痫发作风险以及较高的短期 (18%) 和长期 (60%) ADR 风险。干预 包括以下 4 种抗癫痫药物策略： (1) 保守的，包括短期（7 天）二次早期癫痫预防和晚期癫痫发作后的长期治疗；(2) 中度，包括长期的二次早期癫痫预防或晚期癫痫治疗；(3) 积极的，包括长期的初级预防；(4) 风险指导，包括低风险患者的短期二级早期癫痫预防（2HELPS2B 评分，0）、高风险患者的短期初级预防（2HELPS2B 评分，≥1）和长期预防晚期癫痫发作的长期二级治疗。主要结果和测量质量调整生命年 (QALYs)。结果 对于情景 1，风险引导策略（8.13 QALYs）优于保守（8.08 QALYs）、中度（8.07 QALYs）和激进（7.88 QALYs）策略。对于情景 2，保守策略（2.18 QALYs）优于风险引导（2.17 QALYs）、中度（2.09 QALYs）和激进（1.15 QALYs）策略。对于情景 3，激进策略（9.21 QALYs）优于风险引导（8.98 QALYs）、中度（8.93 QALYs）和保守（8.77 QALYs）策略。对于情景 4，风险引导策略（11.53 QALYs）优于保守（11.23 QALYs）、中度（10.93 QALYs）和激进（8.08 QALYs）策略。敏感性分析表明，在大多数情况下，短期策略（保守和风险导向）是首选，在大多数情况下，风险引导策略的表现与替代策略相当或更好。结论和相关性 该决策分析模型表明短期（7 天）预防在 sICH 后的长期治疗中占主导地位。对于所有 sICH 患者，应考虑使用 2HELPS2B 评分来指导临床决策，以启动短期初级或次级早期癫痫预防。