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

Abstract

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.

Acute epileptiform abnormalities are the primary predictors of post‐stroke epilepsy: a matched, case–control study

“…A total of 36 cases and 72 controls were included in the study from a previously described cohort of stroke patients undergoing cEEG 7 . Among the 38 (11.1%) out of 341 AIS patients who developed PSE, two were excluded due to lack of matching controls.…”

“…A total of 36 cases and 72 controls were included in the study from a previously described cohort of stroke patients undergoing cEEG. 7 Among the 38 (11.1%) out of 341 AIS patients who developed PSE, two were excluded due to lack of matching controls. The included cases and controls were well matched by age at the time of AIS (66 years, p = 0.96) and duration of follow-up (33 months; p = 0.95).…”

“…Therefore, their use in patients at high risk of PSE, individualized based on the identification of acute EAs, could potentially prevent seizures in the immediate post‐hospitalization period and aid in uninterrupted rehabilitation. Conversely, the absence of acute EAs could help to avoid the indiscriminate long term use of ASMs after hospital discharge 7 . Additionally, the 12‐times increased odds of PSE in stroke patients with acute EAs can help to select a highly enriched, at‐risk cohort for PSE development.…”

Acute Symptomatic Seizure Associated With Chronic Antiseizure Medication Use After Stroke

“…Prior findings guided this generous 6-month period because an overwhelming majority of patients continue ASMs beyond an average of 50 days postdischarge (first poststroke clinic visit). 10 The inclusion criteria for the study population were adults (18 years or older) diagnosed with acute stroke from April 1, 2012 to March 31, 2018, underwent cEEG monitoring in the acute period (≤7 days of stroke) because of ASyS concerns, and had at least 6 months of follow-up. To reduce selection bias, we included patients if their ASMs were discontinued or they developed PSE within 6 months of follow-up (Figure 1).…”

SOP Epileptische Anfälle auf der Intensivstation

“…Im intensivmedizinischen Alltag werden dennoch häufig nach einem akut-symptomatischen Anfall Therapien mit ASM begonnen [9]. Leider werden diese üblicherweise ambulant unkritisch fortgeführt [17].…”