Prophylactic Use of Antiepileptic Drugs in Patients with Spontaneous Intracerebral Hemorrhage.
BACKGROUND
The effect of prophylactic antiepileptic drugs (AEDs) on mortality and functional outcome in patients with intracerebral hemorrhage (ICH) is uncertain.


METHODS
We used data from the Virtual International Stroke Trials Archive (VISTA) to evaluate the effect of prophylactic AEDs on ICH outcome. Univariate and multivariate logistic and Cox regression models were designed to determine the impact of prophylactic AEDs on mortality and disability, defined as a modified Rankin Scale (mRS) greater than 3 at 90 days following ICH.


RESULTS
Of the 802 patients with ICH, 81 (10%) received prophylactic AEDs. Patients who received AED prophylaxis had higher ICH volume (median 23.2 cm(3) [IQR 10.5-38.0] versus 14.3 cm(3) [IQR 7.1-27.0], P= .001) and ICH score (median 1 cm(3) [IQR 0-2] versus 1 cm(3) [IQR 0-1], P = .03). In univariate analyses, AED prophylaxis was associated with higher probability of mRS greater than 3 at 90 days (62% versus 49%, P = .03) and a trend towards increased mortality (27% versus 18%, P = .06). Although seizure did not influence ICH outcome, any AED prophylaxis and phenytoin use in particular were both associated with mRS greater than 3 at 90 days (OR 1.66 [1.04-2.66], P = .03 for any AED; OR 1.97 [1.06-3.67], P = .03 for phenytoin prophylaxis) in univariate analyses. After adjustment for components of the ICH score, none of these associations remained significant.


CONCLUSIONS
Patients with higher ICH scores and larger hemorrhages are more likely to receive prophylactic AEDs. We found no independent effect of prophylactic AED treatment on outcome after ICH.
Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.
Ali
A
Zandieh
Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.
Steven R
SR
Messé
Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.
Brett
B
Cucchiara
Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.
Michael T
MT
Mullen
Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: kasner@mail.med.upenn.edu.
Scott E
SE
Kasner
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000927:Anticonvulsants / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
D000927:Anticonvulsants
Intracerebral hemorrhage; antiepileptic drugs; mortality; outcome