Medication use in poststroke epilepsy: A descriptive study on switching of antiepileptic drug treatment

K. Bekelaar; J. H. van Tuijl; E. P. M. van Raak; R. J. van Oostenbrugge; A. P. Aldenkamp; R. P. W. Rouhl

doi:10.1016/j.yebeh.2019.07.035

Medication use in poststroke epilepsy: A descriptive study on switching of antiepileptic drug treatment

K. Bekelaar, J. H. van Tuijl, E. P. M. van Raak, R. J. van Oostenbrugge, A. P. Aldenkamp, R. P. W. Rouhl^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objective: Currently, as evidence-based guidelines are lacking, in patients with poststroke epilepsy (PSE), the choice of the first antiepileptic drug (AED) is left over to shared decision by the treating physician and patient. Although, it is not uncommon that patients with PSE subsequently switch their first prescribed AED to another AED, reasons for those switches are not reported yet. In the present study, we therefore assessed the reasons for switching the first prescribed AED in patients with PSE.

Method: We gathered a hospital-based case series of 53 adult patients with poststroke epilepsy and assessed the use of AEDs, comedication, and the reasons for switches between AEDs during treatment. We also determined the daily drug dose (DDD) at the switching moment.

Results: During a median follow-up of 62 months (Interquartile range [IQR] 69 months), 21 patients (40%) switched their first prescribed AED. Seven patients switched AED at least once because of ineffectivity only or a combination of ineffectivity and side effects, whereas 14 patients switched AED at least once because of side effects only. The DDD was significantly (p <0.001) higher in case ofmedication switches due to ineffectivity (median 1.20, IQR 0.33) compared to switching due to side effects (median 0.67, IQR 0.07). Therewas no difference in the use of comedication between the group that switched because of ineffectivity compared to the group that switched because of side effects.

Conclusion: In our case series, up to 40% of patients with epilepsy after stroke needed to switch their first prescribed AED, mostly because of side effects in lower dosage ranges. (C) 2019 The Authors. Published by Elsevier Inc.

Original language	English
Article number	106434
Number of pages	3
Journal	Epilepsy & Behavior
Volume	104
DOIs	https://doi.org/10.1016/j.yebeh.2019.07.035
Publication status	Published - Mar 2020
Event	1st International Conference on Seizures and Stroke - Gothenburg, Sweden Duration: 1 Feb 2019 → …

Keywords

Poststroke epilepsy
Epilepsy
Antiepileptic drugs
CARBAMAZEPINE
LAMOTRIGINE
SEIZURES

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Cite this

@article{bff7ca056fc144ae928566535b135fcf,

title = "Medication use in poststroke epilepsy: A descriptive study on switching of antiepileptic drug treatment",

abstract = "Objective: Currently, as evidence-based guidelines are lacking, in patients with poststroke epilepsy (PSE), the choice of the first antiepileptic drug (AED) is left over to shared decision by the treating physician and patient. Although, it is not uncommon that patients with PSE subsequently switch their first prescribed AED to another AED, reasons for those switches are not reported yet. In the present study, we therefore assessed the reasons for switching the first prescribed AED in patients with PSE.Method: We gathered a hospital-based case series of 53 adult patients with poststroke epilepsy and assessed the use of AEDs, comedication, and the reasons for switches between AEDs during treatment. We also determined the daily drug dose (DDD) at the switching moment.Results: During a median follow-up of 62 months (Interquartile range [IQR] 69 months), 21 patients (40%) switched their first prescribed AED. Seven patients switched AED at least once because of ineffectivity only or a combination of ineffectivity and side effects, whereas 14 patients switched AED at least once because of side effects only. The DDD was significantly (p <0.001) higher in case ofmedication switches due to ineffectivity (median 1.20, IQR 0.33) compared to switching due to side effects (median 0.67, IQR 0.07). Therewas no difference in the use of comedication between the group that switched because of ineffectivity compared to the group that switched because of side effects.Conclusion: In our case series, up to 40% of patients with epilepsy after stroke needed to switch their first prescribed AED, mostly because of side effects in lower dosage ranges. (C) 2019 The Authors. Published by Elsevier Inc.",

keywords = "Poststroke epilepsy, Epilepsy, Antiepileptic drugs, CARBAMAZEPINE, LAMOTRIGINE, SEIZURES",

author = "K. Bekelaar and {van Tuijl}, {J. H.} and {van Raak}, {E. P. M.} and {van Oostenbrugge}, {R. J.} and Aldenkamp, {A. P.} and Rouhl, {R. P. W.}",

note = "Publisher Copyright: {\textcopyright} 2019 The Authors; 1st International Conference on Seizures and Stroke ; Conference date: 01-02-2019",

year = "2020",

month = mar,

doi = "10.1016/j.yebeh.2019.07.035",

language = "English",

volume = "104",

journal = "Epilepsy & Behavior",

issn = "1525-5050",

publisher = "Elsevier Science",

}

TY - JOUR

T1 - Medication use in poststroke epilepsy

T2 - 1st International Conference on Seizures and Stroke

AU - Bekelaar, K.

AU - van Tuijl, J. H.

AU - van Raak, E. P. M.

AU - van Oostenbrugge, R. J.

AU - Aldenkamp, A. P.

AU - Rouhl, R. P. W.

PY - 2020/3

Y1 - 2020/3

N2 - Objective: Currently, as evidence-based guidelines are lacking, in patients with poststroke epilepsy (PSE), the choice of the first antiepileptic drug (AED) is left over to shared decision by the treating physician and patient. Although, it is not uncommon that patients with PSE subsequently switch their first prescribed AED to another AED, reasons for those switches are not reported yet. In the present study, we therefore assessed the reasons for switching the first prescribed AED in patients with PSE.Method: We gathered a hospital-based case series of 53 adult patients with poststroke epilepsy and assessed the use of AEDs, comedication, and the reasons for switches between AEDs during treatment. We also determined the daily drug dose (DDD) at the switching moment.Results: During a median follow-up of 62 months (Interquartile range [IQR] 69 months), 21 patients (40%) switched their first prescribed AED. Seven patients switched AED at least once because of ineffectivity only or a combination of ineffectivity and side effects, whereas 14 patients switched AED at least once because of side effects only. The DDD was significantly (p <0.001) higher in case ofmedication switches due to ineffectivity (median 1.20, IQR 0.33) compared to switching due to side effects (median 0.67, IQR 0.07). Therewas no difference in the use of comedication between the group that switched because of ineffectivity compared to the group that switched because of side effects.Conclusion: In our case series, up to 40% of patients with epilepsy after stroke needed to switch their first prescribed AED, mostly because of side effects in lower dosage ranges. (C) 2019 The Authors. Published by Elsevier Inc.

AB - Objective: Currently, as evidence-based guidelines are lacking, in patients with poststroke epilepsy (PSE), the choice of the first antiepileptic drug (AED) is left over to shared decision by the treating physician and patient. Although, it is not uncommon that patients with PSE subsequently switch their first prescribed AED to another AED, reasons for those switches are not reported yet. In the present study, we therefore assessed the reasons for switching the first prescribed AED in patients with PSE.Method: We gathered a hospital-based case series of 53 adult patients with poststroke epilepsy and assessed the use of AEDs, comedication, and the reasons for switches between AEDs during treatment. We also determined the daily drug dose (DDD) at the switching moment.Results: During a median follow-up of 62 months (Interquartile range [IQR] 69 months), 21 patients (40%) switched their first prescribed AED. Seven patients switched AED at least once because of ineffectivity only or a combination of ineffectivity and side effects, whereas 14 patients switched AED at least once because of side effects only. The DDD was significantly (p <0.001) higher in case ofmedication switches due to ineffectivity (median 1.20, IQR 0.33) compared to switching due to side effects (median 0.67, IQR 0.07). Therewas no difference in the use of comedication between the group that switched because of ineffectivity compared to the group that switched because of side effects.Conclusion: In our case series, up to 40% of patients with epilepsy after stroke needed to switch their first prescribed AED, mostly because of side effects in lower dosage ranges. (C) 2019 The Authors. Published by Elsevier Inc.

KW - Poststroke epilepsy

KW - Epilepsy

KW - Antiepileptic drugs

KW - CARBAMAZEPINE

KW - LAMOTRIGINE

KW - SEIZURES

U2 - 10.1016/j.yebeh.2019.07.035

DO - 10.1016/j.yebeh.2019.07.035

M3 - Article

C2 - 31477535

SN - 1525-5050

VL - 104

JO - Epilepsy & Behavior

JF - Epilepsy & Behavior

M1 - 106434

Y2 - 1 February 2019

ER -