Prophylactic Anticonvulsants in Intracerebral Hemorrhage

Jason Mackey, Ashley D. Blatsioris, Elizabeth A S Moser, Ravan J L Carter, Chandan Saha, Alec Stevenson, Abigail L. Hulin, Darren P. O’Neill, Aaron Cohen-Gadol, Thomas J. Leipzig, Linda Williams

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background and Purpose: Prophylactic anticonvulsants are routinely prescribed in the acute setting for intracerebral hemorrhage (ICH) patients, but some studies have reported an association with worse outcomes. We sought to characterize the prevalence and predictors of prophylactic anticonvulsant administration after ICH as well as guideline adherence. We also sought to determine whether prophylactic anticonvulsants were independently associated with poor outcome. Methods: We performed a retrospective study of primary ICH in our two academic centers. We used a propensity matching approach to make treated and non-treated groups comparable. We conducted multiple logistic regression analysis to identify independent predictors of prophylactic anticonvulsant initiation and its association with poor outcome as measured by modified Rankin score. Results: We identified 610 patients with primary ICH, of whom 98 were started on prophylactic anticonvulsants. Levetiracetam (97%) was most commonly prescribed. Age (OR 0.97, 95% CI 0.95–0.99, p < .001), lobar location (OR 2.94, 95% CI 1.76–4.91, p < .001), higher initial National Institutes of Health Stroke Scale (NIHSS) score (OR 2.31, 95% CI 1.40–3.79, p = .001), craniotomy (OR 3.06, 95% CI 1.51–6.20, p = .002), and prior ICH (OR 2.36, 95% CI 1.10–5.07, p = .028) were independently associated with prophylactic anticonvulsant initiation. Prophylactic anticonvulsant use was not associated with worse functional outcome [modified Rankin score (mRS) 4–6] at hospital discharge or with increased case-fatality. There was no difference in prescribing patterns after 2010 guideline publication. Discussion: Levetiracetam was routinely prescribed following ICH and was not associated with worse outcomes. Future investigations should examine the effect of prophylactic levetiracetam on cost and neuropsychological outcomes as well as the role of continuous EEG in identifying subclinical seizures.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalNeurocritical Care
DOIs
StateAccepted/In press - Mar 21 2017

Fingerprint

Cerebral Hemorrhage
etiracetam
Anticonvulsants
Guideline Adherence
Partial Epilepsy
Craniotomy
National Institutes of Health (U.S.)
Publications
Electroencephalography
Retrospective Studies
Logistic Models
Stroke
Regression Analysis
Guidelines
Costs and Cost Analysis

Keywords

  • Anticonvulsants
  • Guideline adherence
  • Health services
  • Intracerebral hemorrhage
  • Outcomes

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Clinical Neurology

Cite this

Prophylactic Anticonvulsants in Intracerebral Hemorrhage. / Mackey, Jason; Blatsioris, Ashley D.; Moser, Elizabeth A S; Carter, Ravan J L; Saha, Chandan; Stevenson, Alec; Hulin, Abigail L.; O’Neill, Darren P.; Cohen-Gadol, Aaron; Leipzig, Thomas J.; Williams, Linda.

In: Neurocritical Care, 21.03.2017, p. 1-9.

Research output: Contribution to journalArticle

Mackey, J, Blatsioris, AD, Moser, EAS, Carter, RJL, Saha, C, Stevenson, A, Hulin, AL, O’Neill, DP, Cohen-Gadol, A, Leipzig, TJ & Williams, L 2017, 'Prophylactic Anticonvulsants in Intracerebral Hemorrhage', Neurocritical Care, pp. 1-9. https://doi.org/10.1007/s12028-017-0385-8
Mackey, Jason ; Blatsioris, Ashley D. ; Moser, Elizabeth A S ; Carter, Ravan J L ; Saha, Chandan ; Stevenson, Alec ; Hulin, Abigail L. ; O’Neill, Darren P. ; Cohen-Gadol, Aaron ; Leipzig, Thomas J. ; Williams, Linda. / Prophylactic Anticonvulsants in Intracerebral Hemorrhage. In: Neurocritical Care. 2017 ; pp. 1-9.
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abstract = "Background and Purpose: Prophylactic anticonvulsants are routinely prescribed in the acute setting for intracerebral hemorrhage (ICH) patients, but some studies have reported an association with worse outcomes. We sought to characterize the prevalence and predictors of prophylactic anticonvulsant administration after ICH as well as guideline adherence. We also sought to determine whether prophylactic anticonvulsants were independently associated with poor outcome. Methods: We performed a retrospective study of primary ICH in our two academic centers. We used a propensity matching approach to make treated and non-treated groups comparable. We conducted multiple logistic regression analysis to identify independent predictors of prophylactic anticonvulsant initiation and its association with poor outcome as measured by modified Rankin score. Results: We identified 610 patients with primary ICH, of whom 98 were started on prophylactic anticonvulsants. Levetiracetam (97{\%}) was most commonly prescribed. Age (OR 0.97, 95{\%} CI 0.95–0.99, p < .001), lobar location (OR 2.94, 95{\%} CI 1.76–4.91, p < .001), higher initial National Institutes of Health Stroke Scale (NIHSS) score (OR 2.31, 95{\%} CI 1.40–3.79, p = .001), craniotomy (OR 3.06, 95{\%} CI 1.51–6.20, p = .002), and prior ICH (OR 2.36, 95{\%} CI 1.10–5.07, p = .028) were independently associated with prophylactic anticonvulsant initiation. Prophylactic anticonvulsant use was not associated with worse functional outcome [modified Rankin score (mRS) 4–6] at hospital discharge or with increased case-fatality. There was no difference in prescribing patterns after 2010 guideline publication. Discussion: Levetiracetam was routinely prescribed following ICH and was not associated with worse outcomes. Future investigations should examine the effect of prophylactic levetiracetam on cost and neuropsychological outcomes as well as the role of continuous EEG in identifying subclinical seizures.",
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AU - Saha, Chandan

AU - Stevenson, Alec

AU - Hulin, Abigail L.

AU - O’Neill, Darren P.

AU - Cohen-Gadol, Aaron

AU - Leipzig, Thomas J.

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