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Outcomes after Early Anticonvulsant Discontinuation in Aneurysmal Subarachnoid Hemorrhage

BACKGROUND: Empiric use of anticonvulsant (AED) for seizure prophylaxis in aneurysmal subarachnoid hemorrhage (SAH) remains controversial and may be associated with worse SAH outcome. We determined the safety and feasibility of early discontinuation of empiric AED in a select cohort of SAH patients....

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Autores principales: Chou, Sherry Hsiang-Yi, Latorre, Julius Gene Silva, Alpargu, Gulhan, Ogilvy, Christopher S, Sorond, Farzaneh A, Rordorf, Guy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8460122/
https://www.ncbi.nlm.nih.gov/pubmed/34568512
http://dx.doi.org/10.4172/2329-6925.1000173
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author Chou, Sherry Hsiang-Yi
Latorre, Julius Gene Silva
Alpargu, Gulhan
Ogilvy, Christopher S
Sorond, Farzaneh A
Rordorf, Guy
author_facet Chou, Sherry Hsiang-Yi
Latorre, Julius Gene Silva
Alpargu, Gulhan
Ogilvy, Christopher S
Sorond, Farzaneh A
Rordorf, Guy
author_sort Chou, Sherry Hsiang-Yi
collection PubMed
description BACKGROUND: Empiric use of anticonvulsant (AED) for seizure prophylaxis in aneurysmal subarachnoid hemorrhage (SAH) remains controversial and may be associated with worse SAH outcome. We determined the safety and feasibility of early discontinuation of empiric AED in a select cohort of SAH patients. METHODS: In a cohort of 166 consecutive SAH patients, a subset underwent early AED discontinuation if they were awake and following commands after aneurysm treatment. We examined the effect of AED discontinuation on seizure incidence, mortality and functional outcome at discharge using logistic regression and validated results using 70%-30% data partition. RESULTS: Seventy-three subjects underwent AED discontinuation. Patient groups had similar gender, age, Fisher grade, incidence of craniotomy, vasospasm, ischemic infarct, intraventricular and intraparenchymal hemorrhages. Hunt-Hess (HH) grade were lower in AED-discontinuation group. Clinical or electrographic seizure occurred in 1/93 (1%) patients on AED and 0/73 patient in AED-discontinuation group. Crude mortality was 24% in patients on AED and 2.7% off AED. After adjusting for age, HH grade, vasospasm, ischemic infarct, intracerebral, and intraventricular hemorrhage, AED discontinuation remains independently associated with lower mortality and higher odds of discharge to home (p=0.0002). AED use is not associated with angiographic vasospasm on exploratory analysis. CONCLUSION: AED discontinuation in SAH patients who are awake and following commands post aneurysm treatment is safe, feasible, and associated with better outcome at hospital discharge. A larger, prospective study is necessary to determine if empiric AED use in SAH leads to poorer functional status.
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spelling pubmed-84601222021-09-23 Outcomes after Early Anticonvulsant Discontinuation in Aneurysmal Subarachnoid Hemorrhage Chou, Sherry Hsiang-Yi Latorre, Julius Gene Silva Alpargu, Gulhan Ogilvy, Christopher S Sorond, Farzaneh A Rordorf, Guy J Vasc Med Surg Article BACKGROUND: Empiric use of anticonvulsant (AED) for seizure prophylaxis in aneurysmal subarachnoid hemorrhage (SAH) remains controversial and may be associated with worse SAH outcome. We determined the safety and feasibility of early discontinuation of empiric AED in a select cohort of SAH patients. METHODS: In a cohort of 166 consecutive SAH patients, a subset underwent early AED discontinuation if they were awake and following commands after aneurysm treatment. We examined the effect of AED discontinuation on seizure incidence, mortality and functional outcome at discharge using logistic regression and validated results using 70%-30% data partition. RESULTS: Seventy-three subjects underwent AED discontinuation. Patient groups had similar gender, age, Fisher grade, incidence of craniotomy, vasospasm, ischemic infarct, intraventricular and intraparenchymal hemorrhages. Hunt-Hess (HH) grade were lower in AED-discontinuation group. Clinical or electrographic seizure occurred in 1/93 (1%) patients on AED and 0/73 patient in AED-discontinuation group. Crude mortality was 24% in patients on AED and 2.7% off AED. After adjusting for age, HH grade, vasospasm, ischemic infarct, intracerebral, and intraventricular hemorrhage, AED discontinuation remains independently associated with lower mortality and higher odds of discharge to home (p=0.0002). AED use is not associated with angiographic vasospasm on exploratory analysis. CONCLUSION: AED discontinuation in SAH patients who are awake and following commands post aneurysm treatment is safe, feasible, and associated with better outcome at hospital discharge. A larger, prospective study is necessary to determine if empiric AED use in SAH leads to poorer functional status. 2015-01-24 2015 /pmc/articles/PMC8460122/ /pubmed/34568512 http://dx.doi.org/10.4172/2329-6925.1000173 Text en https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Article
Chou, Sherry Hsiang-Yi
Latorre, Julius Gene Silva
Alpargu, Gulhan
Ogilvy, Christopher S
Sorond, Farzaneh A
Rordorf, Guy
Outcomes after Early Anticonvulsant Discontinuation in Aneurysmal Subarachnoid Hemorrhage
title Outcomes after Early Anticonvulsant Discontinuation in Aneurysmal Subarachnoid Hemorrhage
title_full Outcomes after Early Anticonvulsant Discontinuation in Aneurysmal Subarachnoid Hemorrhage
title_fullStr Outcomes after Early Anticonvulsant Discontinuation in Aneurysmal Subarachnoid Hemorrhage
title_full_unstemmed Outcomes after Early Anticonvulsant Discontinuation in Aneurysmal Subarachnoid Hemorrhage
title_short Outcomes after Early Anticonvulsant Discontinuation in Aneurysmal Subarachnoid Hemorrhage
title_sort outcomes after early anticonvulsant discontinuation in aneurysmal subarachnoid hemorrhage
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8460122/
https://www.ncbi.nlm.nih.gov/pubmed/34568512
http://dx.doi.org/10.4172/2329-6925.1000173
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