Levetiracetam versus Carbamazepine in Patients with Late Poststroke Seizures: A Multicenter Prospective Randomized Open-Label Study (EpIC Project)

Consoli, Domenico; Bosco, Domenico; Postorino, Paolo; Galati, Franco; Plastino, Massimiliano; Perticoni, G.; Ottonello, G.A.; Passarella, Bruno; Ricci, Stefano; Neri, G.; Toni, Danilo

doi:10.1159/000342669

Cited by 100 publications

(116 citation statements)

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“…Attention deficit, frontal executive function, and functional scales were significantly worse in the carbamazepine group. Premature discontinuation due to serious adverse effects was not statistically significant between the groups [35]. In a smaller study, 64 patients presenting with the first (early or late) poststroke seizure received lamotrigine or carbamazepine in a randomized 1:1 ratio.…”

Section: Treatmentmentioning

confidence: 88%

“…The authors concluded that gabapentin was safe and useful for poststroke seizures [48]. Other authors randomized 106 patients with late poststroke seizures to levetiracetam or sustained-release carbamazepine [35]. No statistically significant difference in the number of seizure-free patients was found between the two groups.…”

Section: Treatmentmentioning

confidence: 98%

“…Seizure duration may correlate with the intensity and size of these changes. Angiography after seizure may demonstrate a focal area of enhanced blood flow secondary to disruption of the bloodbrain barrier [35]. Cerebral perfusion imaging may also demonstrate large areas of ictal hyperperfusion or postictal hypoperfusion.…”

Section: Imagingmentioning

confidence: 99%

“…Newer-generation AEDs do not demonstrate significant interactions with warfarin or antiplatelet agents [3]. For example, levetiracetam and lamotrigine lack hepatic metabolism and have a favorable pharmacokinetic profile in terms of drug interaction, compared to older AED [35,46]. Animal models and clinical studies suggested that older AEDs may impair the recovery after stroke.…”

Section: Treatmentmentioning

confidence: 99%

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Seizures in Ischemic Stroke

Kim

Sila

2015

Seizures in Cerebrovascular Disorders

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Section: Treatmentmentioning

confidence: 88%

Section: Treatmentmentioning

confidence: 98%

Section: Imagingmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Seizures in Ischemic Stroke

Kim

Sila

2015

Seizures in Cerebrovascular Disorders

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“…No randomized clinical trials have explored the evaluation of older versus newer AEDs in stroke-related epilepsy. However, the newer agents offer the advantage of fewer side effects, which makes them appropriate to use particularly in the elderly [14,15,35]. A few studies have shown gabapentin and lamotrigine to be effective in the treatment of late-onset poststroke seizures [16,17].…”

Section: Managementmentioning

confidence: 99%

Medical Management of Seizures in Cerebrovascular Disorders

Menon

Leppik

2015

Seizures in Cerebrovascular Disorders

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Cerebrovascular disorders are one of the most common identifiable causes of epilepsy, especially in the elderly [1]. Seizures after a stroke can occur early, within 7-14 days [2-6], or late, after 14 days [7][8][9][10]. Early seizures do not necessarily progress to epilepsy, but may result in increased morbidity and mortality. Reports vary considerably regarding the incidence of single seizures and epilepsy after a stroke. In adults younger than 50 years of age, 12.7 % with ischemic strokes and 25.6 % with intracranial hemorrhage developed epilepsy. This study used the more recent definition of epilepsy, which is the occurrence of a single seizure associated with an enduring condition associated with epilepsy. Another large study reported the occurrence of seizures in 168 (8.9 %) of 1897 persons following an ischemic stroke and 28 (10.6 %) of 265 after a hemorrhagic stroke [4]. Most seizures occurred within 2 years of the stroke.A critical question addressing the issue of treatment is the occurrence of a second seizure after a single seizure. Unfortunately, this is a difficult question to answer from the literature. Many physicians initiate treatment with antiepileptic drugs (AEDs) following a single seizure because of the perception that there is a high risk of additional seizures in the context of stroke and seizure. Thus, reports of recurrent seizures are confounded with treatment, and it is difficult to establish the risk of epilepsy as defined by two or more unprovoked seizures. In one study by Arntz, 75 % of persons with an ischemic stroke and 80 % with a hemorrhagic stroke were

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Seizure Prophylaxis After Spontaneous Intracerebral Hemorrhage

et al. 2021

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IMPORTANCELimited evidence is available concerning optimal seizure prophylaxis after spontaneous intracerebral hemorrhage (sICH).OBJECTIVE To evaluate which of 4 seizure prophylaxis strategies provides the greatest net benefit for patients with sICH. DESIGN, SETTING, AND PARTICIPANTSThis decision analysis used models to simulate the following 4 common scenarios: (1) a 60-year-old man with low risk of early (Յ7 days after stroke) (10%) and late (3.6% or 9.8%) seizures and average risk of short-(9%) and long-term (30%) adverse drug reaction (ADR); (2) an 80-year-old woman with low risk of early (10%) and late (3.6% or 9.8%) seizures and high short-(24%) and long-term (80%) ADR risks; (3) a 55-year-old man with high risk of early (19%) and late (34.8% or 46.2%) seizures and low short-(9%) and long-term (30%) ADR risks; and (4) a 45-year-old woman with high risk of early (19%) and late (34.8% or 46.2%) seizures and high short-(18%) and long-term (60%) ADR risks. INTERVENTIONSThe following 4 antiseizure drug strategies were included: (1) conservative, consisting of short-term (7-day) secondary early-seizure prophylaxis with long-term therapy after late seizure; (2) moderate, consisting of long-term secondary early-seizure prophylaxis or late-seizure therapy; (3) aggressive, consisting of long-term primary prophylaxis; and (4) risk guided, consisting of short-term secondary early-seizure prophylaxis among low-risk patients (2HELPS2B score, 0), short-term primary prophylaxis among patients at higher risk (2HELPS2B score, Ն1), and long-term secondary therapy for late seizure. MAIN OUTCOMES AND MEASURESQuality-adjusted life-years (QALYs). RESULTSFor scenario 1, the risk-guided strategy (8.13 QALYs) was preferred over the conservative (8.08 QALYs), moderate (8.07 QALYs), and aggressive (7.88 QALYs) strategies. For scenario 2, the conservative strategy (2.18 QALYs) was preferred over the risk-guided (2.17 QALYs), moderate (2.09 QALYs), and aggressive (1.15 QALYs) strategies. For scenario 3, the aggressive strategy (9.21 QALYs) was preferred over the risk-guided (8.98 QALYs), moderate (8.93 QALYs), and conservative (8.77 QALYs) strategies. For scenario 4, the risk-guided strategy (11.53 QALYs) was preferred over the conservative (11.23 QALYs), moderate (10.93 QALYs), and aggressive (8.08 QALYs) strategies. Sensitivity analyses suggested that short-term strategies (conservative and risk guided) are preferred under most scenarios, and the risk-guided strategy performs comparably to or better than alternative strategies in most settings.CONCLUSIONS AND RELEVANCE This decision analytical model suggests that short-term (7-day) prophylaxis dominates longer-term therapy after sICH. Use of the 2HELPS2B score to guide clinical decisions for initiation of short-term primary vs secondary early-seizure prophylaxis should be considered for all patients after sICH.

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Levetiracetam versus Carbamazepine in Patients with Late Poststroke Seizures: A Multicenter Prospective Randomized Open-Label Study (EpIC Project)

Cited by 100 publications

References 60 publications

Seizures in Ischemic Stroke

Seizures in Ischemic Stroke

Medical Management of Seizures in Cerebrovascular Disorders

Seizure Prophylaxis After Spontaneous Intracerebral Hemorrhage

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