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December 2022; 12 (6) Research Article

Acute Symptomatic Seizure Associated With Chronic Antiseizure Medication Use After Stroke

MarieElena Byrnes, Pradeep Chandan, Christopher Newey, Stephen Hantus, Vineet Punia
First published October 12, 2022, DOI: https://doi.org/10.1212/CPJ.0000000000200085
MarieElena Byrnes
The Charles Schor Epilepsy Center (PC, CN, SH, VP), Neurological Institute, Cleveland Clinic, OH; and Cerebrovascular Center (CN), Neurological Institute, Cleveland Clinic, OH.
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Pradeep Chandan
The Charles Schor Epilepsy Center (PC, CN, SH, VP), Neurological Institute, Cleveland Clinic, OH; and Cerebrovascular Center (CN), Neurological Institute, Cleveland Clinic, OH.
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Christopher Newey
The Charles Schor Epilepsy Center (PC, CN, SH, VP), Neurological Institute, Cleveland Clinic, OH; and Cerebrovascular Center (CN), Neurological Institute, Cleveland Clinic, OH.
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Stephen Hantus
The Charles Schor Epilepsy Center (PC, CN, SH, VP), Neurological Institute, Cleveland Clinic, OH; and Cerebrovascular Center (CN), Neurological Institute, Cleveland Clinic, OH.
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Vineet Punia
The Charles Schor Epilepsy Center (PC, CN, SH, VP), Neurological Institute, Cleveland Clinic, OH; and Cerebrovascular Center (CN), Neurological Institute, Cleveland Clinic, OH.
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Citation
Acute Symptomatic Seizure Associated With Chronic Antiseizure Medication Use After Stroke
MarieElena Byrnes, Pradeep Chandan, Christopher Newey, Stephen Hantus, Vineet Punia
Neurol Clin Pract Dec 2022, 12 (6) e154-e161; DOI: 10.1212/CPJ.0000000000200085

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Abstract

Background and Objective Patients with acute symptomatic seizures (ASyS) after stroke are discharged on antiseizure medications (ASMs) and stay on them for an extended period. We analyzed the current ASM management practice, 6 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 (April 1, 2012 to March 31, 2018) with at least 6 months of follow-up was performed. ASM use beyond 6 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 and 52% female patients) patients (41.9% ischemic stroke, 36.1% intracerebral hemorrhage, and 21.9% subarachnoid hemorrhage) 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 (poststroke 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-month (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 NIH Stroke Scale Score (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).

Discussion 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.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Submitted and externally peer reviewed. The handling editor was Editor Luca Bartolini, MD.

  • Received May 25, 2022.
  • Accepted August 17, 2022.
  • © 2022 American Academy of Neurology
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