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Prophylactic Anticonvulsants in Intracerebral Hemorrhage

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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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Funding

This work was supported by awards from the IU Health Values Fund (IUH VFR365), the IU CTSI PDT (ICTSI NIH/NCRR RR025761), the IUH/IUSM Strategic Research Initiative, and an IU CTSI KL2 award (NIH, UL1TR001108, Shekhar PI).

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Authors and Affiliations

  1. Department of Neurology, Indiana University School of Medicine, 355 West 16th St, Suite 3200, Indianapolis, IN, USA

    Jason Mackey, Ashley D. Blatsioris, Alec Stevenson, Abigail L. Hulin & Linda S. Williams

  2. Regenstrief Institute, Indianapolis, IN, USA

    Jason Mackey, Ravan J. L. Carter & Linda S. Williams

  3. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA

    Elizabeth A. S. Moser & Chandan Saha

  4. Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA

    Darren P. O’Neill

  5. Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Aaron A. Cohen-Gadol & Thomas J. Leipzig

  6. Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA

    Linda S. Williams

Authors
  1. Jason Mackey
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  2. Ashley D. Blatsioris
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  3. Elizabeth A. S. Moser
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  4. Ravan J. L. Carter
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  5. Chandan Saha
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  6. Alec Stevenson
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  7. Abigail L. Hulin
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  8. Darren P. O’Neill
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  9. Aaron A. Cohen-Gadol
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  10. Thomas J. Leipzig
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  11. Linda S. Williams
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Corresponding author

Correspondence to Jason Mackey.

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Conflict of interest

Dr. Mackey is funded by Research Grant; Significant; IUH-VFR-365, IUH/IUSM Strategic Research Initiative, and CTSI PDT; NIH LRP recipient; Indiana University CTSI KL2 award recipient. A.D. Blatsioris, E.A.S. Moser, R.J.L. Carter, C. Saha, A. Stevenson, and A.L. Hulin are funded by Research Grant; Significant; IUH-VFR-365, IUH/IUSM Strategic Research Initiative. Drs. O’Neill, Cohen-Gadol, Leipzig, and Williams report no disclosures.

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Mackey, J., Blatsioris, A.D., Moser, E.A.S. et al. Prophylactic Anticonvulsants in Intracerebral Hemorrhage. Neurocrit Care 27, 220–228 (2017). https://doi.org/10.1007/s12028-017-0385-8

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  • DOI: https://doi.org/10.1007/s12028-017-0385-8

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