Abstracts

Rationale: There is no consensus regarding antiepileptic drug (AED) choice in patients with poststroke epilepsy (PSE). Enzyme-inducing AEDs have been linked to increased cardiovascular risk and may interact with drugs used in secondary stroke prevention. Reviews often mention lamotrigine, levetiracetam (LEV), and gabapentin as appealing treatment options, but the influence of these recommendations on clinical practice in Sweden is unknown. As part of a project on the impact of poststroke epilepsy on mortality, we have investigated first AED prescriptions among patients with PSE in Sweden. Methods: Patients with a stroke during the years 2005-2010 were identified using the Swedish stroke register (n=131330). The extracted data was cross-linked to three other national records for information on epilepsy, date of death, and dispensed drugs. 31/12/2014 was declared the final point of data capture. 7790 patients met our criteria for PSE, i.e., a detected ICD-10-code for epilepsy, seizures, or status epilepticus (G40, G41, or R56.8) more than seven days after stroke. Having a record of AED dispensations before PSE (n=1530) or being under 18 years of age at stroke onset (n=2) resulted in exclusion, leaving 6258 patients for further analysis. Results: Overall, carbamazepine (CBZ) was the most commonly employed first AED (47.5%), with valproic acid (VPA, 18.9%) and LEV (11.1%) in second and third place, respectively. In 2005, CBZ accounted for 43.7% of all initial prescriptions, followed by VPA at 27.1% and phenytoin at 10.2%. In 2014, LEV was the most commonly prescribed first AED (49.4%), followed by CBZ (25.9%) and VPA (11.1%). 1267 patients did not have any record of AED dispensations. Conclusions: Although the initial prescription pattern is trending for second-generation AEDs – with an emphasis on LEV – first-generation AEDs, and CBZ in particular, are still commonly employed as first treatment in patients with PSE in Sweden. Further studies will be conducted on associations between particular AEDs and prognosis. Funding: Jeansson foundation, Swedish society of medicine, Magnus Bergvall fondation, Gothenburg society of medicine