Acute Symptomatic Seizure Associated With Chronic Antiseizure Medication Use After Stroke

Abstract

Background:Patients with acute-symptomatic seizures (ASyS) after stroke are discharged on anti-seizure medications (ASMs) and stay on them for an extended period. We analyzed the current ASM management practice, six months, and at the last follow-up after stroke-related ASyS concerns to identify chronic and long-term ASM use predictors.Methods:A single-center, retrospective cohort study of adults who underwent continuous EEG monitoring for ASyS concerns after stroke (04/01/2012 to 03/31/2018) with at least six months of follow-up was performed. ASM use beyond six months after the initial ASyS concern was defined as ‘chronic’ among patients discharged on them. ‘Long-term’ ASM use at the last follow-up in all patients with ASyS concerns was analyzed. Logistic regression and Cox-regression multivariable modeling to analyze predictors of ‘chronic’ and ‘long-term’ ASM use, respectively, was performed.Results:A total of 465 (mean age 61.7 ±13.3 years; 52% females) patients (41.9% ischemic stroke, 36.1% ICH, 21.9% SAH) were included. Of the 179 (38.5%) patients discharged on ASMs, 132 (73.7%; 28.4% of study population) had chronic ASM use, despite 90% not experiencing any seizure [post-stroke epilepsy (PSE)] during this time. The independent predictors of chronic ASM use were electrographic ASyS [Odds ratio (OR) = 9.27, 95%CI = 2.53 – 60.4], and female sex (OR = 2.2, 95% CI = 1.02 – 4.83). After a median 61 months (5.1 years) follow-up, 101 (21.7%) patients in the study population were on long-term ASM use, including 67 (14.4%) who developed PSE. Long-term ASM use was associated with NIHSS (OR = 1.5, 95% CI = 1.015 – 1.98), cortical involvement (OR = 1.28, 95% CI = 1.02 – 1.6), convulsive ASyS (OR = 1.46, 95% CI = 1.02 – 2.09), epileptiform findings on outpatient EEG (OR = 4.03, 95% CI = 1.28 – 12.76), and PSE development (OR = 7.06, 95% CI = 3.7 – 13.4).Conclusions:Chronic ASM use is highly associated with electrographic, rather than convulsive, ASyS. However, long-term ASM use is independently associated with PSE and its risk factors, including convulsive ASyS. With the ubiquity of stroke-related ASyS concerns in routine clinical practice, comparative effectiveness studies to guide ASM management are needed.

Editorial: Acute symptomatic seizures and epileptiform abnormalities: Management and outcomes

“…The latter does not show any benefit in neonates ( 28 ). Due to a lack of data guiding optimal ASM duration in adults, a majority continue ASMs several months to years after hospital discharge ( 29 , 30 ). There is a large variability of expert recommendation on the duration of ASM continuation after ASyS and EAs ranging from months to years ( 31 , 32 ).…”