Discontinuation of preventive antiepileptic drugs in patients with intracerebral hemorrhage

Yi-Sin Wong,Chi-Shun Wu,Cheung-Ter Ong

doi:10.1186/s12883-021-02177-w

Abstract

BackgroundThe risk factors for seizures in patients with intracerebral hemorrhage (ICH) stroke and the effect of seizure prevention by anticonvulsant are not well understood. Limited studies have investigated the risk of seizure after discontinuing antiepileptic drugs in patients with ICH. This study aimed to investigate the role of valproic acid (VA) for seizure prevention and to access the risk of seizure after anticonvulsant withdrawal in patients with spontaneous ICH.MethodsBetween 2013 and 2015, 177 patients with ICH were enrolled in this 3-year retrospective study. Seizures were classified as early seizure (first seizure within 1 week of ICH), delayed seizure (first seizure after 1 week), and late seizure (any seizure after 1 week). Binary logistic regression was used to evaluate the relationship between baseline clinical factors and late seizures between study periods. VA was prescribed or discontinued based on the decision of the physician in charge.ResultsSeizures occurred in 24 patients, including early seizure in 6.78% (12/177) of the patients, delayed seizure in 7.27% (12/165) of the patients without early seizure, and late seizure in 9.60% (17/177) of the patients. Most seizures occurred within the first year. Binary logistic regression analysis showed ICH with cortex involvement as the independent risk factor for seizures. VA did not decrease the risk of seizures. Patients with ICH with cortical involvement using anticonvulsants for longer than 3 months did not have a decreased risk of seizures (odds ratio 1.86, 95% CI: 0.43–8.05).ConclusionsSpontaneous ICH with cortex involvement is the risk factor for seizure. Most seizures occurred within 1 year after stroke onset over a 3-year follow up. Discontinuation of antiepileptic drug within 3 months in patients does not increase the risk of seizure.

Highlights

The risk factors for seizures in patients with intracerebral hemorrhage (ICH) stroke and the effect of seizure prevention by anticonvulsant are not well understood
After excluding the patients who died within 2 years, were lost to follow-up, or had epilepsy and brain tumor, 177 patients were included in the analysis
Of the 12 patients who had Early seizure (ES), 50% (6/12) of the seizures occurred within 24 h after stroke onset

Summary

Introduction

The risk factors for seizures in patients with intracerebral hemorrhage (ICH) stroke and the effect of seizure prevention by anticonvulsant are not well understood. This study aimed to investigate the role of valproic acid (VA) for seizure prevention and to access the risk of seizure after anticonvulsant withdrawal in patients with spontaneous ICH. In patients with early seizure, approximately 50% seizures were found to occur at the onset of intracerebral hemorrhage (ICH) [5]. A previous study reported that patients with stroke who have experienced early seizure have a higher risk of developing late seizure than those who have not [9]. A study by Biffi et al, including 872 patients, found that after 3.9 years of follow up, approximately 50% (42/86) of the patients with early seizure experienced recurrent seizure, and 4.24% (37/872) experienced late seizure [10]

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