Anti-seizure Medication Use and Outcomes in Hospitalized Patients Undergoing Continuous EEG Monitoring - A Multicenter Study
Abstract number :
2.252
Submission category :
7. Anti-seizure Medications / 7C. Cohort Studies
Year :
2022
Submission ID :
2205053
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Hunter Rice, BS – Massachusetts General Hospital; Natalie Erlich-Malona, MD MSc – Brown University; Fernando Ibanhes, BS – Brown University; Muhammad Adnan Haider, MD MSc – Massachusetts General Hospital; Elizabeth Tveter, BS – Massachusetts Generel Hospital; Vineet Punia, MD MS – Cleveland Clinical Foundation; Adithya Sivaraju, MD MS – Yale University; Clio Rubinos, MD MS – University of North Carolina; Monica Dhakar, MD – Brown University; Sahar Zafar, MD MSc – Massachusetts General Hospital
Rationale: Anti-seizure medications (ASMs) are increasingly used for the treatment of acute symptomatic seizures (ASyS) and epileptiform abnormalities (EA) (e.g., periodic and rhythmic patterns) in hospitalized patients. To date, there is limited data on the risk/benefit ratio of ASM treatment. The goal of this multi-center study was to determine the predictors of ASM use in hospitalized patients undergoing continuous EEG (cEEG) monitoring, and explore the relation of ASM use with outcomes._x000D_
Methods: This is a retrospective cohort study of hospitalized patients (age >18 years) that underwent cEEG monitoring between July 1, 2021, and September 30, 2021, at the member institutes of the post-acute symptomatic seizure investigations and outcomes network (PASSION). Patients with history of epilepsy were excluded. Baseline clinical and demographic variables, disease etiology, comorbidities and cEEG findings were recorded. ASM treatment was defined as treatment continuation > 48 hours. Multivariable logistic regression was performed to determine predictors of (1) ASM treatment initiation, (2) ASM prescription at discharge, and (3) association of ASM treatment with in-hospital mortality. The multivariable analysis included baseline clinical and demographic variables, underlying disease etiology, disease severity as measured by the Glasgow Coma Scale, and cEEG findings including presence or absence of seizures and other EA._x000D_
Results: A total of 955 patients (45.9% females; median age 64 years Cleveland Clinic = 466, Massachusetts General Hospital = 166, Yale University = 96, UNC Chapel Hill = 106, Rhode Island Hospital = 121) were included. 416 (43.6%) patients were initiated on new ASM treatment ( >48 hours). 241(32% of patients alive at discharge) were discharged on ASMs. The in-hospital mortality rate was 21% (n=202). On multivariable analysis, significant predictors of ASM initiation included acute brain injury (ABI) [odds ratio (OR) = 3.45 (95% CI = 1.93-6.27)], brain neoplasm [OR = 4.31 (2.11- 8.78)], cerebral inflammatory diseases [OR = 4.12 (1.22-13.85)], traumatic brain injury (TBI) [OR = 4.13 (2.3-7.33)], clinical ASyS[OR = 4.75 (3.20-7.05)], electrographic seizures [OR = 7.91 (3.65-17.17)], and EA [OR = 2.31 (1.63-3.26)]. Significant predictors of ASM prescription at discharge included primary diagnosis of brain neoplasm [OR = 4.26 (1.82-9.93)], clinical ASyS [OR = 13.5 (8.43-21.63)], electrographic seizures [OR = 23.7 (8.03-70.46)], EA [OR = 1.59 (1.01-2.51)], and neurosurgery as the primary discharge service [OR = 2.30 (1.18-4.47)]. After adjusting for clinical and demographic variables, disease type and severity and cEEG findings, new ASM treatment was not significantly associated with in-hospital mortality [OR = 0.85 (0.53-1.36)]._x000D_
Conclusions: While patients with ASyS, EAs, ABI and tumors are frequently treated with ASMs, there was no association between treatment and in-hospital mortality. Further comparative effectiveness studies are indicated to determine if prolonged ASM treatment improves long-term outcomes.
Funding: American Epilepsy Society Infrastructure Grant
Anti-seizure Medications