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Seizure outcome and anti-seizure medication use in post-stroke epilepsy: A retrospective cohort study
Ahmed Khadija1, Jacques Theitler2, Revital Gandelman-Marton2
1Neurology Department, Shamir-Assaf Harofeh Medical Center, Tel Aviv University, Zerifin, Israel.
Background:
Most patients with post-stroke epilepsy (PSE) are considered to be well controlled with anti-seizure medications (ASMs). First-generation ASMs with potent enzyme-inducing properties can reduce the efficacy of concomitant medications and were related to increased mortality in PSE.
Objective:
To evaluate seizure outcome and patterns of ASM use in patients with PSE.
Methods:
We retrospectively reviewed the computerized database and the medical records of all the patients who had their first visit in our adult outpatient epilepsy clinic during a 10-year period (2012-2021), and identified 39 patients with PSE and 382 patients with focal epilepsy without a previous stroke (FEWS).
Results:
The study group included 421 patients aged 18-90 years, 220 (52.3 %) men, follow-up duration 3.1 ± 2.9 years. At first observation, patients with PSE had lower rates of daily to monthly seizures (p = 0.023) and higher rates of a single seizure (p = 0.023) compared to patients with FEWS, and 66 % were treated with first-generation ASMs. At last observation, seizure frequency improved in fewer patients with PSE compared to FEWS (p = 0.042), with significant decrease in the rate of daily to monthly seizures in patients with FEWS (p = 0.0001).
Conclusions:
Seizure outcome in patients with PSE may be less favorable than previously reported, and many were still treated with ASMs that can adversely affect vascular risk. Further studies are needed to evaluate therapeutic strategies that can improve seizure control and achieve higher rates of seizure freedom in patients with PSE.
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