Table 2.

Summary of society guideline recommendations on PSS prophylaxis.

Guidelines		Primary prophylaxis	Secondary prophylaxis
European Stroke Organisation (36)		Weak recommendation against primary prophylaxis	EPSS: only a weak recommendation can be made in favour of secondary prophylaxis, and we suggest not generally employing secondary ASM prophylaxis. LPSS: employing secondary ASM prophylaxis after one unprovoked seizure needs to be considered.
American Heart Association/ American Stroke Association	Ischaemic stroke (136)	Not recommended	Recurrent seizures should be treated in a manner similar to when they occur with acute neurological conditions; ASMs should be selected based on patient characteristics
	Spontaneous intracerebral haemorrhage (125)	Should not be treated prophylactically with ASMs	Recommended to improve functional outcomes and prevent brain injury from prolonged seizures
	Aneurysmal SAH (126)	Benefit of routine administration after aneurysmal SAH not supported by evidence; prophylactic ASM use may be reasonable to prevent seizures in patients with aneurysmal SAH if accompanied by high seizure-risk features	Both EPSS and LPSS warrant longer-term antiseizure medication that should be managed in the postoperative period by a clinician who specialises in seizure management.