Anticonvulsant Use and Outcomes After Intracerebral Hemorrhage
Anticonvulsant Use and Outcomes After Intracerebral Hemorrhage
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DOI：
10.1161/strokeaha.109.559948
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发表时间：
2009-12-01
期刊：
影响因子：
8.3
通讯作者：
Batjer, H. Hunt
中科院分区：
文献类型：
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作者：
Naidech, Andrew M.;Garg, Rajeev K.;Batjer, H. Hunt
背景和目的——关于脑出血后抗癫痫药物治疗的有效性和副作用的数据很少。我们检验了抗癫痫药物的使用与脑出血后更多的并发症和更差的结果相关的假设。方法-我们前瞻性地招募了 98 名脑出血患者，并记录了作为预防性或治疗性的抗癫痫药物的使用情况以及临床特征。从电子病历中检索抗癫痫药物给药和游离苯妥英血清水平。精神状态抑郁的患者接受持续脑电图监测。在出院后 14 天或出院时使用美国国立卫生研究院卒中量表和改良 Rankin 量表以及在 28 天和 3 个月时使用改良 Rankin 量表测量结果。我们使用前向条件模型构建了 3 个月时不良结果的逻辑回归模型。结果 - 7 名 (7%) 患者出现临床癫痫发作，其中 5 名患者在脑出血当天发生。苯妥英与更严重的发烧相关（P = 0.03），第 14 天时美国国立卫生研究院卒中量表较差（23 [ 9 至 42] 与 11 [ 4 至 23]，P = 0.003），以及第 14 天、28 天和 3 个月时改良 Rankin 量表较差。在正向条件 Logistic 回归模型中，苯妥英预防与不良结局风险增加相关（OR，9.8；1.4 至 68.6；P = 0.02），入院后输入美国国立卫生研究院卒中量表和年龄。排除癫痫发作的患者并没有改变结果。左乙拉西坦与人口统计学、癫痫发作、并发症或结果无关。结论：苯妥英与脑出血后发烧加剧和结局更差有关。 （中风。2009；40：3810-3815。）
Background and Purpose-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. (Stroke. 2009; 40: 3810-3815.)