Abstracts

Rationale: Limited data is available on the prescribing patterns, efficacy and safety profiles of newer generation antiepileptic drugs (AEDs) in the setting of hospitalized patients, especially in the critically ill population. AED usage in this population group is typically reported in small case series with variable data collection methods. Since hospitalized patients often have multiorgan dysfunction, new adverse effects may occur that were not identified in randomized clinical trials. The aim of this study is to develop a standardized assessment tool for efficacy and adverse effects of new AEDs in hospitalized patients.  Methods: A standardized data collection tool was developed after reviewing AED adverse effect reporting guidelines, grading scales and questionnaires, as well as clinical trials assessing AED efficacy in hospitalized patients with seizures. This assessment tool was then used in a retrospective chart review study at two hospitals (Beth Israel Deaconess Medical Center and Brigham and Women’s Hospital). Adult patients (age >18) who were started on one of three newer generation AEDs (Brivaracetam-BRV, Clobazam-CLB, and Perampanel-PMP) during hospitalization between 2014-2018 were included. Results: This standardized assessment tool consists of six basic modules: demographics, baseline disease/epilepsy characteristics, current admission characteristics, new AED prescription pattern, efficacy and adverse effects. A total of 51 patients were identified: BRV (N=11), CLB (N=30) and PMP (N=10). Patient demographics and baseline disease characteristics did not differ significantly among the three AED groups except that PMP group presented with lower Glasgow Coma Scale upon admission (BRV 13.8 vs. CLB 12.4 vs. PMP 9.3, p0.1). Secondary outcome included: days in hospital after new AED administration (no significant difference), functional status at time of discharges (no significant difference), and frequency of adverse events (BRV 0/10, vs. CLB 1/11: fatigue and PMP 3/10: somnolence, hives and increased seizure frequency).  Conclusions: We developed a standardized assessment tool for documenting usage pattern, preliminary efficacy and adverse events of newer generation AEDs in hospitalized patients with seizures. This tool was then validated and refined in a retrospective chart review study to compare three new AEDs in hospitalized patients. This tool will facilitate centralized data collection and comparative study of different new AEDs in hospitalized patients. Future research direction is to utilize this tool in a prospective, multi-center, observational study.  Funding: American Epilepsy Society / Epilepsy Foundation Clinical Research Apprenticeship (10/2017-10/2018)