JAMA Netw Open

Antiseizure medication doesn't appear to reduce epilepsy risk after brain abscess

August 6, 2025

Study details: This retrospective cohort study emulated a target trial using U.S. commercial insurance claims data (2016–2022) to assess whether starting antiseizure medications (ASMs: levetiracetam, valproate, phenytoin) within 45 days of brain abscess diagnosis reduces subsequent epilepsy risk. Adults with acute brain abscess and no prior epilepsy or ASM use were included.

Results: Among 572 patients (mean age, 61.5 years; 61.7% male), 16.4% initiated ASMs. During follow-up, 22.5% developed epilepsy. There was no statistically significant difference in epilepsy incidence at 90, 135, or 180 days between those who did and didn't receive ASMs (e.g., risk difference at 180 days: 3.5% [95% confidence interval, –4.4% to 10.8%]).

Clinical impact: Findings suggest that routine initiation of ASMs after brain abscess doesn't reduce epilepsy risk in the first 6 months. This supports the European Society of Clinical Microbiology and Infectious Diseases guideline recommendation against prophylactic ASM use in this setting, highlighting the need for individualized decision-making and further research.

Source:

Nielsen VM, et al. (2025, August 1). JAMA Netw Open. Initiation of Antiseizure Medications in Patients With Brain Abscess. https://pubmed.ncbi.nlm.nih.gov/40748638/