Abstracts

Rationale: Antiepileptic drugs (AEDs) are frequently initiated in patients with intracerebral hemorrhages without definite seizures or other clear indications. We sought to determine the percentage of patients with spontaneous intraparenchymal hemorrhages (IPH) or intraventricular hemorrhages (IVH), who experience seizures at onset or during hospitalization, the percentage of patients who were started on an AED, and the percentage of patients discharged on AEDs in the absence of a clinical or electrographic seizure. Two cohorts 10 years apart were examined to evaluate changing trends in management, especially in the setting of recent increased use of EEG monitoring in such patients.Methods: Using a clinical data registry at a tertiary care adult hospital, we retrospectively selected all admissions for spontaneous IPH and IVH between 1/1/99 - 12/31/00 (Cohort A), and 1/1/09 12/31/10 (Cohort B), confirmed by head CT. Exclusion criteria were vascular anomalies, trauma, primary subarachnoid and subdural bleeds, hemorrhagic infarcts and malignancies, resulting in 30 of 200 patients in Cohort A and 108 of 520 patients in Cohort B for analysis. The following clinical data were analyzed in both cohorts: demographics, seizure history, hemorrhage location, neurosurgical intervention, hemorrhage volume on CT scan, hemorrhage expansion, presence of associated subarachnoid, subdural and intraventricular hemorrhages, and presence of clinical or electrographic seizures at presentation or any time prior to discharge. We assessed use of AEDs during hospitalization and at time of discharge.Results: Seizures occurred in 6.7% (n=2) and 12.0% (n=13) of patients in Cohort A and Cohort B, respectively. In Cohort A, 6.7% (n=2) patients had clinical seizures either on presentation or during admission. In Cohort B, 8.3% patients (n=9) had clinical seizures on presentation and 7.4% (n=8) had clinical or electrographic seizures during hospitalization. In Cohort A, 53.3% (n=16) patients were started or loaded with an AED at some point during hospitalization, and 50% (n=15) were discharged on an AED. In Cohort B, 50% (n=54) patients were started on an AED, and 20.4% (n=22) were discharged on an AED. Of the patients in Cohort B who were discharged on an AED, 12.0% (n=13) did not have a clinical or electrographic seizure, or epileptiform findings on their EEG.Conclusions: The proportion of patients started on AEDs was similar in both cohorts, but AEDs were more often discontinued in patients in the new cohort. This reflects a change of practice over a decade due to practice parameter guidelines (Guidelines for the Management of Spontaneous Intracerebral Hemorrhage, Stroke, 2007) as well as more widespread continuous EEG monitoring. In both cohorts, a proportion of patients who were started or discharged on AEDs may not have an indication to be on them. A prospective study with continuous EEG monitoring on all patients with cerebral hemorrhages and altered mental status is required to further study the indication of AEDs.