Prophylactic Anticonvulsants in Intracerebral Hemorrhage.
OBJECTIVE
Prophylactic anticonvulsants are routinely prescribed in the acute setting for intracerebral hemorrhage (ICH) patients, but some studies have reported an association with worse outcomes. We sought to characterize the prevalence and predictors of prophylactic anticonvulsant administration after ICH as well as guideline adherence. We also sought to determine whether prophylactic anticonvulsants were independently associated with poor outcome.


METHODS
We performed a retrospective study of primary ICH in our two academic centers. We used a propensity matching approach to make treated and non-treated groups comparable. We conducted multiple logistic regression analysis to identify independent predictors of prophylactic anticonvulsant initiation and its association with poor outcome as measured by modified Rankin score.


RESULTS
We identified 610 patients with primary ICH, of whom 98 were started on prophylactic anticonvulsants. Levetiracetam (97%) was most commonly prescribed. Age (OR 0.97, 95% CI 0.95-0.99, p < .001), lobar location (OR 2.94, 95% CI 1.76-4.91, p < .001), higher initial National Institutes of Health Stroke Scale (NIHSS) score (OR 2.31, 95% CI 1.40-3.79, p = .001), craniotomy (OR 3.06, 95% CI 1.51-6.20, p = .002), and prior ICH (OR 2.36, 95% CI 1.10-5.07, p = .028) were independently associated with prophylactic anticonvulsant initiation. Prophylactic anticonvulsant use was not associated with worse functional outcome [modified Rankin score (mRS) 4-6] at hospital discharge or with increased case-fatality. There was no difference in prescribing patterns after 2010 guideline publication.


CONCLUSIONS
Levetiracetam was routinely prescribed following ICH and was not associated with worse outcomes. Future investigations should examine the effect of prophylactic levetiracetam on cost and neuropsychological outcomes as well as the role of continuous EEG in identifying subclinical seizures.
Department of Neurology, Indiana University School of Medicine, 355 West 16th St, Suite 3200, Indianapolis, IN, USA. jsmackey@iupui.edu.|Regenstrief Institute, Indianapolis, IN, USA. jsmackey@iupui.edu.
Jason
http://orcid.org/0000-0002-6867-8630
J
Mackey
Department of Neurology, Indiana University School of Medicine, 355 West 16th St, Suite 3200, Indianapolis, IN, USA.
Ashley D
AD
Blatsioris
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
Elizabeth A S
EAS
Moser
Regenstrief Institute, Indianapolis, IN, USA.
Ravan J L
RJL
Carter
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
Chandan
C
Saha
Department of Neurology, Indiana University School of Medicine, 355 West 16th St, Suite 3200, Indianapolis, IN, USA.
Alec
A
Stevenson
Department of Neurology, Indiana University School of Medicine, 355 West 16th St, Suite 3200, Indianapolis, IN, USA.
Abigail L
AL
Hulin
Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA.
Darren P
DP
O'Neill
Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Aaron A
AA
Cohen-Gadol
Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Thomas J
TJ
Leipzig
Department of Neurology, Indiana University School of Medicine, 355 West 16th St, Suite 3200, Indianapolis, IN, USA.|Regenstrief Institute, Indianapolis, IN, USA.|Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
Linda S
LS
Williams
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000628:therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010889:Piracetam / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015995:Prevalence; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000517:prevention & control*
D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam
Anticonvulsants; Guideline adherence; Health services; Intracerebral hemorrhage; Outcomes