Long‐term continuation of anti‐seizure medications after acute stroke

Abstract Objective To investigate the factors associated with the long‐term continuation of anti‐seizure medications (ASMs) in acute stroke patients. Methods We performed a retrospective cohort study of stroke patients with concern for acute symptomatic seizures (ASySs) during hospitalization who su...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Vineet Punia, Ryan Honomichl, Pradeep Chandan, Lisa Ellison, Nicolas Thompson, Adithya Sivaraju, Irene Katzan, Pravin George, Chris Newey, Stephen Hantus
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/6192bbaafe2a4a1c8085d691f933e326
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:6192bbaafe2a4a1c8085d691f933e326
record_format	dspace
spelling	oai:doaj.org-article:6192bbaafe2a4a1c8085d691f933e3262021-11-19T13:55:31ZLong‐term continuation of anti‐seizure medications after acute stroke2328-950310.1002/acn3.51440https://doaj.org/article/6192bbaafe2a4a1c8085d691f933e3262021-09-01T00:00:00Zhttps://doi.org/10.1002/acn3.51440https://doaj.org/toc/2328-9503Abstract Objective To investigate the factors associated with the long‐term continuation of anti‐seizure medications (ASMs) in acute stroke patients. Methods We performed a retrospective cohort study of stroke patients with concern for acute symptomatic seizures (ASySs) during hospitalization who subsequently visited the poststroke clinic. All patients had continuous EEG (cEEG) monitoring. We generated a multivariable logistic regression model to analyze the factors associated with the primary outcome of continued ASM use after the first poststroke clinic visit. Results A total of 507 patients (43.4% ischemic stroke, 35.7% intracerebral hemorrhage, and 20.9% aneurysmal subarachnoid hemorrhage) were included. Among them, 99 (19.5%) suffered from ASySs, 110 (21.7%) had epileptiform abnormalities (EAs) on cEEG, and 339 (66.9%) had neither. Of the 294 (58%) patients started on ASMs, 171 (33.7%) were discharged on them, and 156 (30.3% of the study population; 53.1% of patients started on ASMs) continued ASMs beyond the first poststroke clinic visit [49.7 (±31.7) days after cEEG]. After adjusting for demographical, stroke‐ and hospitalization‐related variables, the only independent factors associated with the primary outcome were admission to the NICU [Odds ratio (OR) 0.37 (95% CI 0.15–0.9)], the presence of ASySs [OR 20.31(95% CI 9.45–48.43)], and EAs on cEEG [OR 2.26 (95% CI 1.14–4.58)]. Interpretation Almost a third of patients with poststroke ASySs concerns may continue ASMs for the long term, including more than half started on them acutely. Admission to the NICU may lower the odds, and ASySs (convulsive or electrographic) and EAs on cEEG significantly increase the odds of long‐term ASM use.Vineet PuniaRyan HonomichlPradeep ChandanLisa EllisonNicolas ThompsonAdithya SivarajuIrene KatzanPravin GeorgeChris NeweyStephen HantusWileyarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENAnnals of Clinical and Translational Neurology, Vol 8, Iss 9, Pp 1857-1866 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Vineet Punia Ryan Honomichl Pradeep Chandan Lisa Ellison Nicolas Thompson Adithya Sivaraju Irene Katzan Pravin George Chris Newey Stephen Hantus Long‐term continuation of anti‐seizure medications after acute stroke
description	Abstract Objective To investigate the factors associated with the long‐term continuation of anti‐seizure medications (ASMs) in acute stroke patients. Methods We performed a retrospective cohort study of stroke patients with concern for acute symptomatic seizures (ASySs) during hospitalization who subsequently visited the poststroke clinic. All patients had continuous EEG (cEEG) monitoring. We generated a multivariable logistic regression model to analyze the factors associated with the primary outcome of continued ASM use after the first poststroke clinic visit. Results A total of 507 patients (43.4% ischemic stroke, 35.7% intracerebral hemorrhage, and 20.9% aneurysmal subarachnoid hemorrhage) were included. Among them, 99 (19.5%) suffered from ASySs, 110 (21.7%) had epileptiform abnormalities (EAs) on cEEG, and 339 (66.9%) had neither. Of the 294 (58%) patients started on ASMs, 171 (33.7%) were discharged on them, and 156 (30.3% of the study population; 53.1% of patients started on ASMs) continued ASMs beyond the first poststroke clinic visit [49.7 (±31.7) days after cEEG]. After adjusting for demographical, stroke‐ and hospitalization‐related variables, the only independent factors associated with the primary outcome were admission to the NICU [Odds ratio (OR) 0.37 (95% CI 0.15–0.9)], the presence of ASySs [OR 20.31(95% CI 9.45–48.43)], and EAs on cEEG [OR 2.26 (95% CI 1.14–4.58)]. Interpretation Almost a third of patients with poststroke ASySs concerns may continue ASMs for the long term, including more than half started on them acutely. Admission to the NICU may lower the odds, and ASySs (convulsive or electrographic) and EAs on cEEG significantly increase the odds of long‐term ASM use.
format	article
author	Vineet Punia Ryan Honomichl Pradeep Chandan Lisa Ellison Nicolas Thompson Adithya Sivaraju Irene Katzan Pravin George Chris Newey Stephen Hantus
author_facet	Vineet Punia Ryan Honomichl Pradeep Chandan Lisa Ellison Nicolas Thompson Adithya Sivaraju Irene Katzan Pravin George Chris Newey Stephen Hantus
author_sort	Vineet Punia
title	Long‐term continuation of anti‐seizure medications after acute stroke
title_short	Long‐term continuation of anti‐seizure medications after acute stroke
title_full	Long‐term continuation of anti‐seizure medications after acute stroke
title_fullStr	Long‐term continuation of anti‐seizure medications after acute stroke
title_full_unstemmed	Long‐term continuation of anti‐seizure medications after acute stroke
title_sort	long‐term continuation of anti‐seizure medications after acute stroke
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/6192bbaafe2a4a1c8085d691f933e326
work_keys_str_mv	AT vineetpunia longtermcontinuationofantiseizuremedicationsafteracutestroke AT ryanhonomichl longtermcontinuationofantiseizuremedicationsafteracutestroke AT pradeepchandan longtermcontinuationofantiseizuremedicationsafteracutestroke AT lisaellison longtermcontinuationofantiseizuremedicationsafteracutestroke AT nicolasthompson longtermcontinuationofantiseizuremedicationsafteracutestroke AT adithyasivaraju longtermcontinuationofantiseizuremedicationsafteracutestroke AT irenekatzan longtermcontinuationofantiseizuremedicationsafteracutestroke AT pravingeorge longtermcontinuationofantiseizuremedicationsafteracutestroke AT chrisnewey longtermcontinuationofantiseizuremedicationsafteracutestroke AT stephenhantus longtermcontinuationofantiseizuremedicationsafteracutestroke
_version_	1718420072571076608

Long‐term continuation of anti‐seizure medications after acute stroke

Ejemplares similares