Anticonvulsant use and outcomes after intracerebral hemorrhage

Andrew M. Naidech, Rajeev K. Garg, Storm Liebling, Kimberly Levasseur, Micheal P. MacKen, Stephan U. Schuele, H. Hunt Batjer

Research output: Contribution to journalArticle

139 Scopus citations

Abstract

Background and Purpose-There are few data on the effectiveness and side effects of antiepileptic drug therapy after intracerebral hemorrhage. We tested the hypothesis that antiepileptic drug use is associated with more complications and worse outcome after intracerebral hemorrhage. Methods-We prospectively enrolled 98 patients with intracerebral hemorrhage and recorded antiepileptic drug use as either prophylactic or therapeutic along with clinical characteristics. Antiepileptic drug administration and free phenytoin serum levels were retrieved from the electronic medical records. Patients with depressed mental status underwent continuous electroencephalographic monitoring. Outcomes were measured with the National Institutes of Health Stroke Scale and modified Rankin Scale at 14 days or discharge and the modified Rankin Scale at 28 days and 3 months. We constructed logistic regression models for poor outcome at 3 months with a forward conditional model. Results-Seven (7%) patients had a clinical seizure, 5 on the day of intracerebral hemorrhage. Phenytoin was associated with more fever (P=0.03), worse National Institutes of Health Stroke Scale at 14 days (23 [9 to 42] versus 11 [4 to 23], P=0.003), and worse modified Rankin Scale at 14 days, 28 days, and 3 months. In a forward conditional logistic regression model, phenytoin prophylaxis was associated with an increased risk of poor outcome (OR, 9.8; 1.4 to 68.6; P=0.02), entering after admission National Institutes of Health Stroke Scale and age. Excluding patients with a seizure did not change the results. Levetiracetam was not associated with demographics, seizures, complications, or outcomes. CONCLUSIONS-: Phenytoin was associated with more fever and worse outcomes after intracerebral hemorrhage.

Original languageEnglish (US)
Pages (from-to)3810-3815
Number of pages6
JournalStroke
Volume40
Issue number12
DOIs
StatePublished - Dec 1 2009

Keywords

  • Anticonvulsants
  • Intracerebral hemorrhage
  • Neurocritical care
  • Outcomes
  • Seizures

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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    Naidech, A. M., Garg, R. K., Liebling, S., Levasseur, K., MacKen, M. P., Schuele, S. U., & Batjer, H. H. (2009). Anticonvulsant use and outcomes after intracerebral hemorrhage. Stroke, 40(12), 3810-3815. https://doi.org/10.1161/STROKEAHA.109.559948