Title

Prophylactic Antiepileptics and Seizure Incidence Following Subarachnoid Hemorrhage: A Propensity Score-Matched Analysis

Authors

David Panczykowski, From the Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (D.P., M.P., Y.Z., G.W., W.A., B.J., A.F.D.); and School of Nursing, University of Pittsburgh, PA (E.C.).
Matthew Pease, From the Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (D.P., M.P., Y.Z., G.W., W.A., B.J., A.F.D.); and School of Nursing, University of Pittsburgh, PA (E.C.).
Yin Zhao, From the Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (D.P., M.P., Y.Z., G.W., W.A., B.J., A.F.D.); and School of Nursing, University of Pittsburgh, PA (E.C.).
Gregory Weiner, From the Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (D.P., M.P., Y.Z., G.W., W.A., B.J., A.F.D.); and School of Nursing, University of Pittsburgh, PA (E.C.).
William Ares, From the Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (D.P., M.P., Y.Z., G.W., W.A., B.J., A.F.D.); and School of Nursing, University of Pittsburgh, PA (E.C.).
Elizabeth Crago, From the Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (D.P., M.P., Y.Z., G.W., W.A., B.J., A.F.D.); and School of Nursing, University of Pittsburgh, PA (E.C.).
Brian Jankowitz, From the Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (D.P., M.P., Y.Z., G.W., W.A., B.J., A.F.D.); and School of Nursing, University of Pittsburgh, PA (E.C.).
Andrew F. Ducruet, From the Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (D.P., M.P., Y.Z., G.W., W.A., B.J., A.F.D.); and School of Nursing, University of Pittsburgh, PA (E.C.). ducruetaf@upmc.edu.Follow

Document Type

Article

Abstract

BACKGROUND AND PURPOSE: The utility of prophylactic antiepileptic drug (AED) administration after spontaneous subarachnoid hemorrhage remains controversial. AEDs have not clearly been associated with a reduction in seizure incidence and have been associated with both neurological worsening and delayed functional recovery in this setting. METHODS: We retrospectively analyzed a prospectively collected database of subarachnoid hemorrhage patients admitted to our institution between 2005 and 2010. Between 2005 and 2007, all patients received prophylactic AEDs upon admission. After 2007, no patients received prophylactic AEDs or had AEDs immediately discontinued if initiated at an outside hospital. A propensity score-matched analysis was then performed to compare the development of clinical and electrographic seizures in these 2 populations. RESULTS: Three hundred and fifty three patients with spontaneous subarachnoid hemorrhage were analyzed, 43% of whom were treated with prophylactic AEDs upon admission. Overall, 10% of patients suffered clinical and electrographic seizures, most frequently occurring within 24 hours of ictus (47%). The incidence of seizures did not vary significantly based on the use of prophylactic AEDs (11 versus 8%; P=0.33). Propensity score-matched analyses suggest that patients receiving prophylactic AEDs had a similar likelihood of suffering seizures as those who did not (P=0.49). CONCLUSIONS: Propensity score-matched analysis suggests that prophylactic AEDs do not significantly reduce the risk of seizure occurrence in patients with spontaneous subarachnoid hemorrhage.

Keywords

SAH, antiepileptic drug, propensity score, seizure, subarachnoid hemorrhage

Medical Subject Headings

Adult; Aged; Anticonvulsants (therapeutic use); Databases, Factual; Female; Humans; Incidence; Male; Middle Aged; Propensity Score; Retrospective Studies; Risk Factors; Seizures (drug therapy, epidemiology, etiology, prevention & control); Subarachnoid Hemorrhage (complications)

Publication Date

7-1-2016

Publication Title

Stroke

E-ISSN

1524-4628

Volume

47

Issue

7

First Page

1754

Last Page

60

PubMed ID

27301932

Digital Object Identifier (DOI)

10.1161/STROKEAHA.116.013766

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