Effect of Primary Prophylactic Antiseizure Medication for Seizure Prevention Following Intracerebral Hemorrhage in the ERICH Study.
Effect of Primary Prophylactic Antiseizure Medication for Seizure Prevention Following Intracerebral Hemorrhage in the ERICH Study.
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DOI：
10.1016/j.jstrokecerebrovasdis.2021.106143
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发表时间：
2022-01
影响因子：
2.5
通讯作者：
Mayson, Douglas
中科院分区：
文献类型：
--
作者：
Savalia, Krupa;Sekar, Padmini;Moomaw, Charles J.;Koch, Sebastian;Sheth, Kevin N.;Woo, Daniel;Mayson, Douglas
脑出血（ICH）是所有卒中亚型中发病率和死亡率最高的，临床医生通常给予预防性抗癫痫药物（ASM）作为预防卒中后癫痫发作的一种手段，特别是在脑叶ICH后。然而，由于随机试验有限，缺乏ASM在预防癫痫发作和减少残疾方面有效性的证据。在此，我们报告了一项大型前瞻性观察性研究的分析，该研究评估了主要预防性ASM给药对ICH后癫痫发作和残疾的影响。对入组ERICH研究的1630例ICH患者进行了主要分析。开发了预防性ASM给药的倾向评分，并通过最接近的倾向评分（差异< 0.1）匹配患者。采用McNemar检验比较住院癫痫发作和残疾的发生率，定义为ICH后3个月时改良兰金评分（mRS）≥ 3。在接受主要预防性ASM治疗的815对匹配患者中，癫痫发作发生率（p = 0.4631）或残疾（p = 0.4653）无显著差异。对280对匹配的原发性脑叶ICH患者进行的亚组分析同样显示，接受药物治疗的患者和未接受药物治疗的患者在癫痫发作发生率（p = 0.1011）或残疾（p = 1.00）方面无显著差异。虽然目前的指南不推荐ICH后的主要预防性ASM，但临床使用仍然很广泛。ERICH研究的数据未发现一级预防性ASM给药与预防ICH后癫痫发作或减少残疾之间存在关联，因此提供了影响临床实践和患者护理的证据。
Intracerebral hemorrhage (ICH) has the highest morbidity and mortality rate of any stroke subtype and clinicians often administer prophylactic antiseizure medications (ASMs) as a means of preventing post-stroke seizures, particularly following lobar ICH. However, evidence for ASM efficacy in preventing seizures and reducing disability is lacking given limited randomized trials. Herein, we report analysis from a large prospective observational study that evaluates the effect of primary prophylactic ASM administration on seizure occurrence and disability following ICH. Primary analysis was performed on 1630 patients with ICH enrolled in the ERICH study. A propensity score for administration of prophylactic ASM was developed and patients were matched by the closest propensity score (difference < 0.1). McNemar’s test was used to compare occurrence of in-hospital seizure and disability, defined by modified Rankin Score (mRS) ≥ 3 at 3 months post ICH. Of the 815 matched pairs of patients treated with primary prophylactic ASM, there was no significant difference in seizure occurrence (p = 0.4631) or disability (p = 0.4653). Subset analysis of 280 matched pairs of patients with primary lobar ICH similarly revealed no significant difference in seizure occurrence (p = 0.1011) or disability (p = 1.00) between prophylactically treated and untreated patients. Although current guidelines do not recommend primary prophylactic ASM following ICH, clinical use remains widespread. Data from the ERICH study did not find an association between administering primary prophylactic ASM and preventing seizures or reducing disability following ICH, thus providing evidence to influence clinical practice and patient care.
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