Paula R Sanches1,2, Mohammad Tabaeizadeh1,3, Lidia M V R Moura1, Eric S Rosenthal1, Luis Otavio Caboclo4, John Hsu5,6, Elisabetta Patorno7, M Brandon Westover1, Sahar F Zafar8. 1. Lunder 6 Neurosciences Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. 2. Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. 3. Department of Neurology, Baylor College of Medicine, Houston, TX, USA. 4. Department of Clinical Neurophysiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. 5. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. 6. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. 7. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 8. Lunder 6 Neurosciences Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. sfzafar@mgh.harvard.edu.
Abstract
OBJECTIVES: To determine the association of anti-seizure medication (ASM) treatment with outcomes in acute ischemic stroke (AIS) patients undergoing continuous electroencephalography (cEEG). METHODS: Retrospective analysis of AIS patients admitted between 2012 and 2019. The following are the inclusion criteria: age ≥ 18 years and ≥ 16 h of cEEG within the first 7 days of admission. ASM treatment exposure was defined as > 48 h of treatment after the first 24 h of cEEG. The primary outcome measure was 90-day mortality, and the secondary outcome was 90-day functional recovery (Modified Ranking Scale 0-3). Propensity scores were used to adjust for baseline covariates and presence of epileptiform abnormalities (seizures, periodic and rhythmic patterns). RESULTS: One hundred thirteen patients met the inclusion criteria; 39 (34.5%) were exposed to ASM. ASM treatment was not associated with 90-day mortality (propensity adjusted HR 1.0 [0.31-3.27], p = 0.999) or functional outcomes (adjusted HR 0.99 [0.32-3.02], p = 0.989), compared to no treatment. CONCLUSIONS: In our study, ASM treatment in AIS patients with cEEG abnormalities was not significantly associated with a change in 90-day mortality and functional recovery. Larger comparative effectiveness studies are indicated to identify which acute ischemic stroke patients with cEEG abnormalities benefit most from ASM treatment.
OBJECTIVES: To determine the association of anti-seizure medication (ASM) treatment with outcomes in acute ischemic stroke (AIS) patients undergoing continuous electroencephalography (cEEG). METHODS: Retrospective analysis of AIS patients admitted between 2012 and 2019. The following are the inclusion criteria: age ≥ 18 years and ≥ 16 h of cEEG within the first 7 days of admission. ASM treatment exposure was defined as > 48 h of treatment after the first 24 h of cEEG. The primary outcome measure was 90-day mortality, and the secondary outcome was 90-day functional recovery (Modified Ranking Scale 0-3). Propensity scores were used to adjust for baseline covariates and presence of epileptiform abnormalities (seizures, periodic and rhythmic patterns). RESULTS: One hundred thirteen patients met the inclusion criteria; 39 (34.5%) were exposed to ASM. ASM treatment was not associated with 90-day mortality (propensity adjusted HR 1.0 [0.31-3.27], p = 0.999) or functional outcomes (adjusted HR 0.99 [0.32-3.02], p = 0.989), compared to no treatment. CONCLUSIONS: In our study, ASM treatment in AIS patients with cEEG abnormalities was not significantly associated with a change in 90-day mortality and functional recovery. Larger comparative effectiveness studies are indicated to identify which acute ischemic stroke patients with cEEG abnormalities benefit most from ASM treatment.
Authors: Jay Gavvala; Nicholas Abend; Suzette LaRoche; Cecil Hahn; Susan T Herman; Jan Claassen; Mícheál Macken; Stephan Schuele; Elizabeth Gerard Journal: Epilepsia Date: 2014-09-29 Impact factor: 5.864
Authors: Mathilde C Hermans; M Brandon Westover; Michel J A M van Putten; Lawrence J Hirsch; Nicolas Gaspard Journal: Clin Neurophysiol Date: 2015-07-02 Impact factor: 3.708
Authors: L J Hirsch; S M LaRoche; N Gaspard; E Gerard; A Svoronos; S T Herman; R Mani; H Arif; N Jette; Y Minazad; J F Kerrigan; P Vespa; S Hantus; J Claassen; G B Young; E So; P W Kaplan; M R Nuwer; N B Fountain; F W Drislane Journal: J Clin Neurophysiol Date: 2013-02 Impact factor: 2.177
Authors: David J Seiffge; Christopher Traenka; Alexandros Polymeris; Lisa Hert; Nils Peters; Philippe Lyrer; Stefan T Engelter; Leo H Bonati; Gian Marco De Marchis Journal: Neurology Date: 2016-09-30 Impact factor: 9.910