Chronic ASM Use Associated With Acute Symptomatic Seizures in Patients With Stroke

Retrospective analysis of a group of individuals with stroke suggests that nonconvulsive acute symptomatic seizures are associated with long-term use of antiseizure medications, providing key data in guiding therapy use in this population.

MarieElena Byrnes, DO, a neurology resident at Cleveland Clinic Neurological Institute

MarieElena Byrnes, DO

Data from a retrospective, single-center cohort study of 465 adults who underwent continuous EEG monitoring for acute symptomatic seizures (ASyS) suggests that chronic antiseizure medication (ASM) use of more than 6 months is associated with nonconvulsive ASyS.1 Data guiding the duration ASM use in this population have been lacking to this point.

“Chronic ASM use is highly associated with electrographic, rather than convulsive, ASyS, with these patients 9 times more likely to be continued on chronic ASMs,” study author MarieElena Byrnes, DO, a neurology resident at Cleveland Clinic Neurological Institute, and colleagues, wrote. “With the ubiquity of stroke-related ASyS concerns in routine clinical practice, comparative effectiveness studies to guide ASM management are needed.”

Byrnes et al presented the date in a poster at the 2022 American Epilepsy Society Annual Meeting, held December 2 to 6, in Nashville, Tennessee. All told, their assessment utilized logistic regression and Cox regression multivariable modeling to assess the predictors of chronic and long-term ASM use, respectively. “Previously, we found that a majority of [patients with stroke] discharged on ASMs continue them beyond their first poststroke clinic visit,” they wrote.

­­Among the 179 patients who were discharged on ASMs, 73.7% (n = 132; 28.4% of total cohort) were still taking ASMs after 6 months, with 90.2.% (n = 119) not developing poststroke epilepsy. Poststroke epilepsy was reported in 4.3% (n = 2) of those on ASMs longer than 6 months (n = 47), and 9.1% (n = 12) of those on ASMs for 6 months or less (n = 132), for an odds ratio (OR) of 2.25 (95% CI, 0.58-14.82; P = 0.3). At the final follow-up (median, 61 months), 21.7% (n = 101) of the total cohort were on ASMs, and 14.4% (n = 67) developed poststroke epilepsy.

On univariable analysis of the characteristics associated with chronic ASM continuation among those discharged on ASMs, women had an adjusted OR of 2.2 (95% CI, 1.02-4.82), which was deemed significant (P = .045). Similarly, electrographic ASyS was associated with an OR of 9.27 (95% CI, 2.53-60.4), which was also significant (P = .004). Electrographic ASyS occurred in 4.3% (n = 2) of those on ASMs longer than 6 months, and 27.3% (n = 36) of those on ASMs 6 months or less, for an OR of 8.44 (95% CI, 2.43-53.34; P = .0004)

Admission duration (OR, 1.05; 95% CI, 1.00-1.11; P = .05) and stroke type—including ischemic stroke (reference), intracranial hemorrhage stroke type (OR, 1.63; 95% CI, 0.7-3.8; P = .25), and subarachnoid hemorrhage (OR, 0.36; 95% CI, 0.12-1.00) were also evaluated but were not significant. Admission duration lasted a median of 11 days (IQR, 5-18) for the overall cohort, lasting 7 days (IQR, 4-15.5) and 11 days (IQR, 6-19) for the cohorts on ASMs longer than 6 months and 6 months or less, respectively.

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REFERENCE
1. Byrnes M, Chandan P, Newey C, Hantus S, Punia V. Acute symptomatic seizure associated chronic anti-seizure medication use after stroke. Presented at: AES Annual Meeting; December 2-6, 2022; Nashville, TN, and virtual.
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