Journal
BRAIN AND BEHAVIOR
Volume 11, Issue 9, Pages -Publisher
WILEY
DOI: 10.1002/brb3.2330
Keywords
antiseizure medication; post-stroke epilepsy; retention; seizure recurrence; tolerability
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Funding
- Practical Research Project for Lifestyle-related Diseases including Cardiovascular Diseases and Diabetes Mellitus from the Japan Agency forMedical Research and Development (AMED) [18ek0210057h0003]
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This study investigated the efficacy of older-generation and newer-generation antiseizure medications in managing post-stroke epilepsy. Results show that newer-generation ASM had lower seizure recurrence rates, better retention, and tolerability compared to older-generation ASM.
Background and purpose The 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. Methods This 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. Results Of 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). Conclusions Newer-generation ASM possess advantages over older-generation ASM for secondary prophylaxis of post-stroke seizures in clinical practice.
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