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Outcomes after Early Anticonvulsant Discontinuation in Aneurysmal Subarachnoid Hemorrhage

Sherry Hsiang-Yi Chou1, Julius Gene Silva Latorre2, Gulhan Alpargu3

  • 1Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, USA.

Journal of Vascular Medicine & Surgery
|September 27, 2021
PubMed

Insights

Early discontinuation of anticonvulsant (AED) in select subarachnoid hemorrhage (SAH) patients is safe and feasible. This approach is linked to improved outcomes, including lower mortality and higher discharge-to-home rates.

Area of Science:

  • Neurology
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Anticonvulsant (AED) use for seizure prophylaxis in aneurysmal subarachnoid hemorrhage (SAH) is debated.
  • Potential negative impacts of AEDs on SAH outcomes necessitate further investigation.

Purpose of the Study:

  • To assess the safety and feasibility of early AED discontinuation in a specific SAH patient cohort.
  • To evaluate the impact of AED discontinuation on seizure incidence, mortality, and functional outcomes.

Main Methods:

  • A cohort of 166 SAH patients was analyzed.
  • Early AED discontinuation was performed in awake patients following commands post-aneurysm treatment.
  • Logistic regression and data partitioning were used to validate findings on seizure incidence, mortality, and functional outcomes.

Main Results:

  • Seventy-three patients underwent AED discontinuation, with similar baseline characteristics to those continuing AEDs, except for lower Hunt-Hess grade.
  • No seizures occurred in the AED discontinuation group (0/73) versus 1% in the AED group (1/93).
  • AED discontinuation was independently associated with significantly lower mortality (2.7% vs 24%) and higher odds of discharge home (p=0.0002).

Conclusions:

  • Early AED discontinuation in awake, responsive SAH patients post-treatment is safe and feasible.
  • This strategy is associated with improved hospital discharge outcomes.
  • Further prospective studies are warranted to confirm if empiric AED use impacts functional status negatively.
Abstract

Keywords:
AnticonvulsantMortalitySubarachnoid hemorrhageVasospasm

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