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Antiseizure Medication Use and Outcomes After Suspected or Confirmed Acute Symptomatic Seizures
JAMA Neurology ( IF 20.4 ) Pub Date : 2024-09-23 , DOI: 10.1001/jamaneurol.2024.3189
Sahar F. Zafar, Adithya Sivaraju, Clio Rubinos, Neishay Ayub, Phillip O. Awodutire, Zachary McKee, Pradeep Chandan, MarieElena Byrnes, Sakhi A. Bhansali, Hunter Rice, Arthor Smith-Ayala, Muhammad Adnan Haider, Elizabeth Tveter, Natalie Erlich-Malona, Fernando Ibanhes, Alexis DeMarco, Skylar Lewis, Monica B. Dhakar, Vineet Punia

ImportanceAntiseizure medications (ASMs) are frequently prescribed for acute symptomatic seizures and epileptiform abnormalities (EAs; eg, periodic or rhythmic patterns). There are limited data on factors associated with ASM use and their association with outcomes.ObjectivesTo determine factors associated with ASM use in patients with confirmed or suspected acute symptomatic seizures undergoing continuous electroencephalography, and to explore the association of ASMs with outcomes.Design, Setting, and ParticipantsThis multicenter cohort study was performed between July 1 and September 30, 2021, at 5 US centers of the Post Acute Symptomatic Seizure Investigation and Outcomes Network. After screening 1717 patients, the study included 1172 hospitalized adults without epilepsy who underwent continuous electroencephalography after witnessed or suspected acute symptomatic seizures. Data analysis was performed from November 14, 2023, to February 2, 2024.ExposureASM treatment (inpatient ASM continuation ≥48 hours).Main Outcomes and MeasuresFactors associated with (1) ASM treatment, (2) discharge ASM prescription, and (3) discharge and 3-month Glasgow Outcome Scale score of 4 or 5 were ascertained.ResultsA total of 1172 patients (median [IQR] age, 64 [52-75] years; 528 [45%] female) were included. Among them, 285 (24%) had clinical acute symptomatic seizures, 107 (9%) had electrographic seizures, and 364 (31%) had EAs; 532 (45%) received ASM treatment. Among 922 patients alive at discharge, 288 (31%) were prescribed ASMs. The respective frequencies of inpatient ASM treatment and discharge prescription were 82% (233 of 285) and 69% (169 of 246) for patients with clinical acute symptomatic seizures, 96% (103 of 107) and 95% (61 of 64) for electrographic seizures, and 64% (233 of 364) and 48% (128 of 267) for EAs. On multivariable analysis, acute and progressive brain injuries were independently associated with increased odds of inpatient ASM treatment (odds ratio [OR], 3.86 [95% CI, 2.06-7.32] and 8.37 [95% CI, 3.48-20.80], respectively) and discharge prescription (OR, 2.26 [95% CI, 1.04-4.98] and 10.10 [95% CI, 3.94-27.00], respectively). Admission to the neurology or neurosurgery service (OR, 2.56 [95% CI, 1.08-6.18]) or to the neurological intensive care unit (OR, 7.98 [95% CI, 3.49-19.00]) was associated with increased odds of treatment. Acute symptomatic seizures and EAs were significantly associated with increased odds of ASM treatment (OR, 14.30 [95% CI, 8.52-24.90] and 2.30 [95% CI, 1.47-3.61], respectively) and discharge prescription (OR, 12.60 [95% CI, 7.37-22.00] and 1.72 [95% CI, 1.00-2.97], respectively). ASM treatment was not associated with outcomes at discharge (OR, 0.96 [95% CI, 0.61-1.52]) or at 3 months after initial presentation (OR, 1.26 [95% CI, 0.78-2.04]). Among 623 patients alive and with complete data at 3 months after discharge, 30 (5%) had postdischarge seizures, 187 (30%) were receiving ASMs, and 202 (32%) had all-cause readmissions.Conclusions and RelevanceThis study suggests that etiology and electrographic findings are associated with ASM treatment for acute symptomatic seizures and EAs; ASM treatment was not associated with functional outcomes. Comparative effectiveness studies are indicated to identify which patients may benefit from ASMs and to determine the optimal treatment duration.

中文翻译:


疑似或确诊急性症状性癫痫发作后的抗癫痫药物使用和结局



重要性抗癫痫药物 (ASMs) 常用于治疗急性症状性癫痫发作和癫痫样异常 (EAs;例如,周期性或节律性模式)。关于 ASM 使用相关因素及其与结局关联的数据有限。目的确定确诊或疑似接受连续脑电图的急性症状性癫痫发作患者使用 ASM 的相关因素,并探讨 ASMs 与结局的相关性。设计、设置和参与者这项多中心队列研究于 2021 年 7 月 1 日至 9 月 30 日在急性症状性癫痫发作后调查和结果网络的 5 个美国中心进行。在筛选了 1717 名患者后,该研究包括 1172 名无癫痫住院成人患者,他们在目击或疑似急性症状性癫痫发作后接受了连续脑电图检查。数据分析于 2023 年 11 月 14 日至 2024 年 2 月 2 日进行≥。主要结局和测量确定了与 (1) ASM 治疗、 (2) 出院 ASM 处方和 (3) 出院和 3 个月格拉斯哥结局量表评分为 4 或 5 分相关的因素。结果共纳入 1172 例患者 (中位 [IQR] 年龄,64 [52-75] 岁;528 [45%] 女性)。其中,285 例 (24%) 有临床急性症状性癫痫发作,107 例 (9%) 有电图癫痫发作,364 例 (31%) 有 EAs;532 例 (45%) 接受 ASM 治疗。在 922 名出院时存活的患者中,288 名 (31%) 接受了 ASM 处方。 临床急性症状性癫痫发作患者住院 ASM 治疗和出院处方的频率分别为 82% (285 例中的 233 例) 和 69% (246 例中的 169 例),电图癫痫发作为 96% (107 例中的 103 例) 和 95% (64 例中的 61 例),以及 EA 为 64% (364 例中的 233 例) 和 48% (267 例中的 128 例)。在多变量分析中,急性和进行性脑损伤与住院 ASM 治疗的几率增加 (比值比 [OR],分别为 3.86 [95% CI,2.06-7.32] 和 8.37 [95% CI,3.48-20.80])和出院处方 (OR,分别为 2.26 [95% CI,1.04-4.98] 和 10.10 [95% CI,3.94-27.00])的增加独立相关。神经内科或神经外科服务 (OR, 2.56 [95% CI, 1.08-6.18]) 或神经重症监护病房 (OR, 7.98 [95% CI, 3.49-19.00]) 与治疗几率增加相关。急性症状性癫痫发作和 EA 与 ASM 治疗 (OR, 14.30 [95% CI, 8.52-24.90] 和 2.30 [95% CI, 1.47-3.61])和出院处方 (OR, 12.60 [95% CI,7.37-22.00] 和 1.72 [95% CI,1.00-2.97] 的几率增加显著相关。ASM 治疗与出院时 (OR, 0.96 [95% CI, 0.61-1.52]) 或初次就诊后 3 个月 (OR, 1.26 [95% CI, 0.78-2.04] ] 的结局无关。在 623 名出院后 3 个月存活且数据完整的患者中,30 名 (5%) 出现出院后癫痫发作,187 名 (30%) 接受 ASMs,202 名 (32%) 全因再入院。结论和相关性本研究表明,病因和心电图发现与急性症状性癫痫发作和 EA 的 ASM 治疗有关;ASM 治疗与功能结局无关。 比较有效性研究旨在确定哪些患者可能从 ASM 中受益并确定最佳治疗持续时间。
更新日期:2024-09-23
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