Effects of phenobarbital and levetiracetam on PR and QTc intervals in patients with post-stroke seizure.
OBJECTIVE
Sudden unexplained/unexpected death (SUDEP) is related to high mortality in patients with epilepsy. The prolongation of QT interval, involved in cardiac arrhythmia-related SUDEP, may be precipitated by antiepileptic drugs (AEDs). In this study, we evaluated the effects of phenobarbital and levetiracetam on PR-QTc intervals in patients with post-stroke seizures.


METHODS
We performed an open-label, parallel group, prospective, multicenter study between June 2009 and December 2013 in patients older than 18 years of age with a clinical diagnosis of post-stroke seizure and treated with phenobarbital or levetiracetam. In order to exclude a role of cerebral post-stroke injury on modulation of PR and QTc intervals, patients with cerebral post-stroke injury and without seizures were also enrolled as controls.


RESULTS
Interictal electrocardiography analysis revealed no significant difference in PR interval between patients treated with an AED (n = 49) and control patients (n = 50) (181.25 ± 12.05 vs. 182.4 ± 10.3 ms; p > 0.05). In contrast, a significantly longer QTc interval was recorded in patients treated with an AED compared with control patients (441.2 ± 56.6 vs. 396.8 ± 49.3 ms; p < 0.01). Patients treated with phenobarbital showed a significantly longer QTc interval than patients treated with levetiracetam (460.0 ± 57.2 vs. 421.5 ± 50.1 ms; p < 0.05).


CONCLUSIONS
The study reported that in patients with late post-stroke seizures, phenobarbital prolonged QTc interval more so than levetiracetam.
Department of Neurology, "Annunziata" Hospital, Cosenza, Italy.
Antonio
A
Siniscalchi
Francesco
F
Scaglione
Enzo
E
Sanzaro
Francesco
F
Iemolo
Giorgio
G
Albertini
Gianluca
G
Quirino
Maria Teresa
MT
Manes
Santo
S
Gratteri
Nicola Biagio
NB
Mercuri
Giovambattista
G
De Sarro
Luca
L
Gallelli
D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010634:Phenobarbital / Q000008:administration & dosage / Q000009:adverse effects*; D010889:Piracetam / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D011446:Prospective Studies; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D016037:Single-Blind Method; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
D000927:Anticonvulsants; D000077287:Levetiracetam; D010634:Phenobarbital; D010889:Piracetam