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Anti-seizure medication treatment and outcomes in acute ischemic stroke patients undergoing continuous EEG monitoring

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Abstract

Objectives

To determine the association of anti-seizure medication (ASM) treatment with outcomes in acute ischemic stroke (AIS) patients undergoing continuous electroencephalography (cEEG).

Methods

Retrospective analysis of AIS patients admitted between 2012 and 2019. The following are the inclusion criteria: age ≥ 18 years and ≥ 16 h of cEEG within the first 7 days of admission. ASM treatment exposure was defined as > 48 h of treatment after the first 24 h of cEEG. The primary outcome measure was 90-day mortality, and the secondary outcome was 90-day functional recovery (Modified Ranking Scale 0–3). Propensity scores were used to adjust for baseline covariates and presence of epileptiform abnormalities (seizures, periodic and rhythmic patterns).

Results

One hundred thirteen patients met the inclusion criteria; 39 (34.5%) were exposed to ASM. ASM treatment was not associated with 90-day mortality (propensity adjusted HR 1.0 [0.31–3.27], p = 0.999) or functional outcomes (adjusted HR 0.99 [0.32–3.02], p = 0.989), compared to no treatment.

Conclusions

In our study, ASM treatment in AIS patients with cEEG abnormalities was not significantly associated with a change in 90-day mortality and functional recovery. Larger comparative effectiveness studies are indicated to identify which acute ischemic stroke patients with cEEG abnormalities benefit most from ASM treatment.

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Acknowledgements

This research was supported by funding from NIH-NINDS K23NS114201 (PI- SFZ).

Funding

Dr. Zafar is supported by funding from NIH K23NS114201 and American Epilepsy Society Infrastructure grant. Dr. Moura is supported by funding from NIH (1K08AG053380-01A1, 1R01AG062282-01) and the Epilepsy Foundation (Epilepsy Learning Healthcare System) and is the Director of the Data Coordinating Center. Dr. Rosenthal is supported by NIH (K23NS105950 and R01NS117904). Dr. Hsu is supported by NIH (P01AG032952 and R01AG062282). Dr. Patorno is supported by multiple grants from NIH (K08AG055670, R01HD097778, 5R01HL141505, U01FD007213), the FDA (5U01FD007213, 75F40119D10037), and PCORI (DB-2020C2-20326). She is an investigator of a research grant to the Brigham and Women’s Hospital from Boehringer Ingelheim, not related to this work. Dr. Westover is supported by the Glenn Foundation for Medical Research and American Federation for Aging Research (Breakthroughs in Gerontology Grant); American Academy of Sleep Medicine (AASM Foundation Strategic Research Award); Football Players Health Study (FPHS) at Harvard University; Department of Defense through a subcontract from Moberg ICU Solutions, Inc.; and NIH (1R01NS102190, 1R01NS102574, 1R01NS107291, 1RF1AG064312).

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Authors and Affiliations

  1. Lunder 6 Neurosciences Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Paula R. Sanches, Mohammad Tabaeizadeh, Lidia M. V. R. Moura, Eric S. Rosenthal, M. Brandon Westover & Sahar F. Zafar

  2. Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil

    Paula R. Sanches

  3. Department of Neurology, Baylor College of Medicine, Houston, TX, USA

    Mohammad Tabaeizadeh

  4. Department of Clinical Neurophysiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil

    Luis Otavio Caboclo

  5. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    John Hsu

  6. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    John Hsu

  7. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Elisabetta Patorno

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by PRS, MT, and SFZ. The first draft of the manuscript was written by PRS and SFZ. All authors commented on, edited, and revised the previous and final versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sahar F. Zafar.

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Conflict of interest

Dr. Zafar is a clinical neurophysiologist for Corticare, unrelated to this work. Dr. Rosenthal received consulting fees from UCB Pharma, Inc. and Ceribell, Inc., unrelated to this work. Dr. Westover is cofounder of Beacon Biosignals unrelated to this work.

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The study was approved by the Institutional Review Board of Mass General Brigham.

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Sanches, P.R., Tabaeizadeh, M., Moura, L.M.V.R. et al. Anti-seizure medication treatment and outcomes in acute ischemic stroke patients undergoing continuous EEG monitoring. Neurol Sci 43, 5441–5449 (2022). https://doi.org/10.1007/s10072-022-06183-9

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