There is no evidence that supports the prophylactic use of antiepileptic drugs. Antiepileptic treatment should be administered in patients with clinically apparent seizures. [Cerebrovasc Dis 2013;35:93–112 https://doi.org/10.1159/000346087 ] However, prophylactic use is not that uncommon too and the use of prophylactic anticonvulsants may be considered in the immediate posthemorrhagic period [https://doi.org/10.1161/STR.0b013e3182587839 ] If used, A short course for 3- 7 days should be considered. However, routine long-term use of antiepileptics is not recommended. Long term use may be considered for patients with known risk factors for delayed seizure disorder, such as prior seizure, intracerebral hematoma, intractable hypertension, infarction, or aneurysm at the middle cerebral artery [https://evidencebasedpractice.osumc.edu/Documents/Guidelines/SAH.pdf ] and [AHA/ASA Guideline Stroke 2012;43:1711-1737]

Prophylactic use of antiepileptic drugs in patients with aneurysmal subarachnoid hemorrhage is a debated issue. Some studies have described that use of antiepileptic drugs is associated with increased in-hospital complications and worse outcome in these patients (Rosengart, 2007). Systematic review of Marigold (2013) found no recent literature supporting the effectiveness of this treatment; and other researchers did not observe any significant reduction of the risk of seizure (Panczykowski, Stroke 2016). The arbitrary differentiation of seizures into early onset and late onset (> 7 days) may have led to doubts about the prophylactic efficacy of these drugs. Therefore, the real problem is this: what are the benefits of using these drugs on the onset of seizures regardless of the time of their appearance?