Antiseizure medications for post-stroke epilepsy: A real-world prospective cohort study.

Tomotaka Tanaka,Yasuhiro Manabe,Shuhei Ikeda,Kazuki Fukuma,Akihiro Shimotake,Junichiro Suzuki,Shigeo Murayama,Naruhiko Kamogawa,Katsuya Kobayashi,Masafumi Ihara,Hajime Yoshimura,Soichiro Abe,Masahiro Mizobuchi,Hiroyuki Ishiyama,Rie Motoyama,Takayuki Matsuki,Masatoshi Koga,Daisuke Onozuka,Riki Matsumoto,Soichiro Matsubara,Kazunori Toyoda,Kunihiro Nishimura,Ryōsuke Takahashi ,Akio Ito ,Propose Study Investigators

doi:10.1002/brb3.2330

Abstract

Background and purposeThe management of post‐stroke epilepsy (PSE) should ideally include prevention of both seizure and adverse effects; however, an optimal antiseizure medications (ASM) regimen has yet been established. The purpose of this study is to assess seizure recurrence, retention, and tolerability of older‐generation and newer‐generation ASM for PSE.MethodsThis prospective multicenter cohort study (PROgnosis of Post‐Stroke Epilepsy [PROPOSE] study) was conducted from November 2014 to September 2019 at eight hospitals. A total of 372 patients admitted and treated with ASM at discharge were recruited. Due to the non‐interventional nature of the study, ASM regimen was not adjusted and followed standard hospital practices. The primary outcome was seizure recurrence in patients receiving older‐generation and newer‐generation ASM. The secondary outcomes were the retention and tolerability of ASM regimens.ResultsOf the 372 PSE patients with ASM at discharge (median [IQR] age, 73 [64–81] years; 139 women [37.4%]), 36 were treated with older‐generation, 286 with newer‐generation, and 50 with mixed‐generation ASM. In older‐ and newer‐generation ASM groups (n = 322), 98 patients (30.4%) had recurrent seizures and 91 patients (28.3%) switched ASM regimen during the follow‐up (371 [347–420] days). Seizure recurrence was lower in newer‐generation, compared with the older‐generation, ASM (hazard ratio [HR], 0.42, 95%CI 0.27–0.70; p = .0013). ASM regimen withdrawal and change of dosages were lower in newer‐generation ASM (HR, 0.34, 95% CI 0.21–0.56, p < .0001).ConclusionsNewer‐generation ASM possess advantages over older‐generation ASM for secondary prophylaxis of post‐stroke seizures in clinical practice.

Highlights

Post-stroke epilepsy (PSE), one of the major sequelae of stroke, is the most common cause of epilepsy in the elderly (Sen et al, 2020)
Seizure recurrence was lower in newer-generation, compared with the older-generation, antiseizure medications (ASM)
Antiseizure medications (ASMs) are the mainstay in seizure control in post-stroke epilepsy (PSE), with most patients generally well controlled by a single dose of ASM (Ryvlin et al, 2006); approximately one-third of PSE patients experience seizure recurrence under ASM treatment within 1 year (Tanaka et al, 2015), and another study demonstrated that approximately 20% of patients with PSE developed pharmaco-resistance and exhibited associations with younger age at stroke onset, stroke type and severity, status epilepticus occurrence, and seizure type (Lattanzi et al, 2021)

Summary

Introduction

Post-stroke epilepsy (PSE), one of the major sequelae of stroke, is the most common cause of epilepsy in the elderly (Sen et al, 2020). According to American and European guidelines (Holtkamp et al, 2017; Winstein et al, 2016 ), use of ASM for secondary prophylaxis of post-stroke seizures has been recommended and newer-generation ASM, levetiracetam (LEV) and lamotrigine (LTG), have been suggested as first-line treatments due to fewer adverse effects (AE) (Ferlazzo et al, 2016; Feyissa et al, 2019) Despite such recommendations, there is currently no established evidence on whether newer-generation ASM are suitable for prevention of PSE (Tanaka & Ihara, 2017). Conclusions: Newer-generation ASM possess advantages over older-generation ASM for secondary prophylaxis of post-stroke seizures in clinical practice

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