Abstracts

Rationale: Post-stroke epilepsy forms a significant proportion of all patients with acquired epilepsy. In the early post-stroke period, seizures are associated with higher morbidity and mortality.  However, little evidence exists guiding the indications and duration of antiepileptic drugs (AEDs) for post-stroke seizure prophylaxis. We performed a retrospective chart review aimed at examining the prescribing practices of AEDs in patients referred for inpatient rehabilitation following an ischemic or hemorrhagic stroke. Methods: The TIRR Memorial Hermann inpatient pharmacy database was searched from December 2013 to December 2014 to identify patients receiving AEDs during admission. These patients’ progress notes and diagnoses at the time of the AED prescriptions were reviewed. Included patients were admitted with primary diagnoses of ischemic or hemorrhagic stroke. Patients were excluded if AEDs were solely prescribed for purposes other than seizure prophylaxis or epilepsy.  Progress notes, diagnoses, and electroencephalogram (EEG) reports were then further searched to classify patients as those with or without a history of seizure. Additional variables collected were demographic characteristics, type and location of stroke, electroencephalographic findings and antiepileptic medications prescribed.  Unpaired t-tests and Chi-Square analyses were used to compare continuous and categorical variables, respectively, and significance was set at a<0.05. Results: We identified 43 patients receiving anti-epileptic medications for an indication of post-stroke epilepsy. Of these 43 patients, 23 (53%) did not have a history of seizures post-stroke. 15 of the 23 patients without a history of seizure had at least one EEG performed, none of which demonstrated any epileptiform activity. 6/23 patients with no history of seizure were prescribed two AEDs. The time from stroke to admission for rehabilitation ranged between 1 week and 16 years with an average of 8.7 ± 19.2 months. We did not find statistically significant differences between patients with a history of seizure (n=20) versus no history of seizure (n=23) in terms of age (mean 58 +/- 13 vs 55 +/- 16 years, p=0.50); gender (7 vs. 10 females, p=0.57); stroke type (12 vs 11 hemorrhagic, p=0.15), and stroke location (11 cortical and 9 subcortical vs. 19 cortical and subcortical, p=0.05). However, power was limited.  Conclusions: More than half the patients prescribed AEDs following stroke in this cohort had no history of seizures following stroke, suggesting that AEDs are overprescribed in acute stroke patients referred for inpatient rehabilitation. Furthermore, over a quarter of patients without a history of seizure were prescribed more than one AED. These preliminary findings highlight the urgent need for prospective studies examining the outcomes and appropriate duration of prescribing AEDs for the prevention of post-stroke seizures following acute hospitalization. Funding: Not applicable