Prophylactic Seizure Medication and Health-Related Quality of Life After Intracerebral Hemorrhage

Naidech, Andrew M.; Beaumont, Jennifer L.; Muldoon, Kathryn; Liotta, Eric M.; Maas, Matthew B.; Potts, Matthew B.; Jahromi, Babak S.; Cella, David; Holl, Jane L.

doi:10.1097/ccm.0000000000003272

Cited by 45 publications

(19 citation statements)

References 36 publications

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“…Recent studies have suggested that prophylactic Levetiracetam for patients with intracerebral haemorrhage was independently associated with lower cognitive function on follow-up [22]. We hope to assess the extent that prophylactic AEDs in TBI impacts long-term cognitive function in future work.…”

Section: Percetage Of Patientsmentioning

confidence: 99%

Impact of anti-epileptic drug choice on discharge in acute traumatic brain injury patients

et al. 2020

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Background Anti-epileptic drug (AED) prophylaxis in the first-seven days post-traumatic brain injury (TBI) is known to reduce seizure frequency acutely. AED efficacy is equivalent; therefore, choice of AED may rest with their side-effects. We hypothesise that AEDs that impair balance will prolong recovery, shown by a longer hospital stay. We compared length of hospital stay (and reported dizziness) in TBI patients receiving the commonest AEDs used in our TBI patients, Phenytoin (which may cause imbalance), and Levetiracetam (which does not affect balance). Method A retrospective observational study was performed on TBI patients admitted to a Major Trauma Unit between October 2013 and June 2018. 100 of 278 patients treated with phenytoin or levetiracetam monotherapy for seizure prophylaxis were included. The inclusion criteria of admission Glasgow Coma Score of 14 or more and length of stay less than 3 weeks minimised confounding variables such as non-ambulant patients. Length of hospital stay and incidence of dizziness were assessed. Results The length of hospital stay was longer for patients on Phenytoin versus Levetiracetam, i.e., 10.74 vs. 7.58 days (p = 0.015; unpaired, two-sided t test). Dizziness reported by patients on phenytoin was 24% and levetiracetam was 8% (p = 0.018; Chi-squared test). Conclusion In this cohort, using Phenytoin for acute TBI, seizure prophylaxis was associated with longer length of stay and more dizziness compared to Levetiracetam. Given their equivalent AED efficacy in acute TBI seizure prophylaxis, our data suggest that Levetiracetam is preferable to Phenytoin for early seizure prophylaxis in TBI. This requires evaluation in larger, prospective studies.

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Section: Percetage Of Patientsmentioning

confidence: 99%

Impact of anti-epileptic drug choice on discharge in acute traumatic brain injury patients

et al. 2020

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“…One of the largest prospective multicenter studies showed the overall incidence of seizures to be about 10.6% following ICH and about 8.6% following ischemic strokes [16]. Additional studies showed seizure activity to be present in up to 10–25% of patients following ICH [32,33], and about 15.2% after SAH [30]. A large recent meta-analysis that did not differentiate from ischemic versus hemorrhage reported an overall 7% risk of stroke-related seizures [7].…”

Section: Incidence Of Post-stroke Seizuresmentioning

confidence: 99%

Incidence, Implications, and Management of Seizures Following Ischemic and Hemorrhagic Stroke

Doria

Forgács

2019

Curr Neurol Neurosci Rep

115

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Purpose of review: In this review we summarize the recent literature regarding incidence and treatment of seizures arising after ischemic and hemorrhagic strokes. Additionally, we identify open questions in guidelines and standard clinical care to aid future studies aim to improve management of seizures in post-stroke patients. Recent findings: Studies demonstrate an increasing prevalence of seizures following strokes, probably a consequence of advances in post-stroke management and expanding use of continuous EEG monitoring. Post-stroke seizures are associated with longer hospitalization and increased mortality; therefore, prevention and timely treatment of seizures is important. The standard of care is to treat recurrent seizures with anti-epileptic drugs (AEDs) regardless of the etiology. However, there are no established guidelines currently for prophylactic use of AEDs following a stroke.

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“…A vast majority of patients experience adverse effects on ASMs, including cognitive slowing, mood problems, and gait instability 18–21 . ASMs interact with other medications, 22 and negatively affect the quality of life after stroke 23 . Therefore, there is a need to better understand the long‐term use of ASMs in stroke patients.…”

Section: Introductionmentioning

confidence: 99%

Long‐term continuation of anti‐seizure medications after acute stroke

Punia

Honomichl

Chandan

et al. 2021

Ann Clin Transl Neurol

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Objective To investigate the factors associated with the long‐term continuation of anti‐seizure medications (ASMs) in acute stroke patients. Methods We performed a retrospective cohort study of stroke patients with concern for acute symptomatic seizures (ASySs) during hospitalization who subsequently visited the poststroke clinic. All patients had continuous EEG (cEEG) monitoring. We generated a multivariable logistic regression model to analyze the factors associated with the primary outcome of continued ASM use after the first poststroke clinic visit. Results A total of 507 patients (43.4% ischemic stroke, 35.7% intracerebral hemorrhage, and 20.9% aneurysmal subarachnoid hemorrhage) were included. Among them, 99 (19.5%) suffered from ASySs, 110 (21.7%) had epileptiform abnormalities (EAs) on cEEG, and 339 (66.9%) had neither. Of the 294 (58%) patients started on ASMs, 171 (33.7%) were discharged on them, and 156 (30.3% of the study population; 53.1% of patients started on ASMs) continued ASMs beyond the first poststroke clinic visit [49.7 (±31.7) days after cEEG]. After adjusting for demographical, stroke‐ and hospitalization‐related variables, the only independent factors associated with the primary outcome were admission to the NICU [Odds ratio (OR) 0.37 (95% CI 0.15–0.9)], the presence of ASySs [OR 20.31(95% CI 9.45–48.43)], and EAs on cEEG [OR 2.26 (95% CI 1.14–4.58)]. Interpretation Almost a third of patients with poststroke ASySs concerns may continue ASMs for the long term, including more than half started on them acutely. Admission to the NICU may lower the odds, and ASySs (convulsive or electrographic) and EAs on cEEG significantly increase the odds of long‐term ASM use.

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Prophylactic Seizure Medication and Health-Related Quality of Life After Intracerebral Hemorrhage

Abstract: Prophylactic levetiracetam was independently associated with lower cognitive function health-related quality of life at follow-up after intracerebral hemorrhage.

Cited by 45 publications

References 36 publications

Impact of anti-epileptic drug choice on discharge in acute traumatic brain injury patients

Impact of anti-epileptic drug choice on discharge in acute traumatic brain injury patients

Incidence, Implications, and Management of Seizures Following Ischemic and Hemorrhagic Stroke

Long‐term continuation of anti‐seizure medications after acute stroke

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