Faculty Collaboration Database

Prophylactic Anticonvulsants in Intracerebral Hemorrhage. Neurocrit Care 2017 Oct;27(2):220-228

Date

03/23/2017

Pubmed ID

28324261

Pubmed Central ID

PMC6522136

DOI

10.1007/s12028-017-0385-8

Scopus ID

2-s2.0-85015725873 (requires institutional sign-in at Scopus site)   18 Citations

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.

Author List

Mackey J, Blatsioris AD, Moser EAS, Carter RJL, Saha C, Stevenson A, Hulin AL, O'Neill DP, Cohen-Gadol AA, Leipzig TJ, Williams LS

Author

Darren P. O'Neill MD Vice Chair, Associate Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Anticonvulsants
Cerebral Hemorrhage
Drug Prescriptions
Female
Guideline Adherence
Humans
Male
Middle Aged
Piracetam
Prevalence
Retrospective Studies
Seizures