Anticonvulsant use and outcomes after intracerebral hemorrhage.
OBJECTIVE
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.
Department of Neurology, Northwestern University, Chicago, IL 60611, USA. a-naidech@northwestern.edu
Andrew M
AM
Naidech
Rajeev K
RK
Garg
Storm
S
Liebling
Kimberly
K
Levasseur
Micheal P
MP
Macken
Stephan U
SU
Schuele
H Hunt
HH
Batjer
D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D003131:Combined Modality Therapy; D003399:Craniotomy; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D016896:Treatment Outcome
D000927:Anticonvulsants; D010672:Phenytoin