RT Journal Article
SR Electronic
T1 Acute Symptomatic Seizure Associated With Chronic Anti-seizure Medication Use After Stroke
JF Neurology: Clinical Practice
FD Lippincott Williams & Wilkins
SP 10.1212/CPJ.0000000000200085
DO 10.1212/CPJ.0000000000200085
A1 MarieElena Byrnes
A1 Pradeep Chandan
A1 Christopher Newey
A1 Stephen Hantus
A1 Vineet Punia
YR 2022
UL http://cp.neurology.org/content/early/2022/10/12/CPJ.0000000000200085.abstract
AB 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.