OBJECTIVE: We aimed to investigate whether the risk of unprovoked seizures differs between patients receiving a brief antiseizure medication (ASM) course during hospitalization and those treated beyond hospital discharge following acute symptomatic seizures (ASyS). METHODS: We performed a single-center, retrospective cohort study of all consecutive adults without epilepsy who received maintenance ASM (≥48 h) after ASyS. All patients underwent continuous electroencephalographic (EEG) monitoring and were divided into those receiving ASMs only during hospitalization and those discharged on ASMs. We used propensity score matching to balance covariates between groups. Cause-specific Cox proportional hazards models analyzed the time to the first unprovoked seizure
death was treated as a competing risk. RESULTS: A total of 144 adults (mean age = 57.4 ± 18.6 years, 48% females) included 118 (82%) patients discharged on ASMs and 26 (18%) who received ASM during hospitalization. During a median follow-up of 24.6 months, 15% experienced an unprovoked seizure. The cumulative incidence of unprovoked seizures at 3, 12, and 36 months was 7.2%, 11.5%, and 17.9%, respectively. ASM status at discharge was significantly associated with electrographic seizures on EEG, etiology, mental status at the time of ASyS, and functional outcome at discharge. After a well-balanced propensity score matching, there was no significant difference in time to unprovoked seizure between patients discharged on ASMs and those who received ASMs only during hospitalization. SIGNIFICANCE: We found that unprovoked seizure risk may not differ significantly between ASyS patients receiving a brief ASM course during hospitalization and those treated for a longer duration after discharge. Although our findings need confirmation in larger studies, they underscore the need for investigating optimal ASM duration in this patient population.