dc.description.abstract |
Post-stroke Epilepsy (PSE) has been identified as a significant clinical
condition in stroke survivors affecting outcome, quality of life, and hospital
cost. They are clinically underestimated without consensus for prophylaxis and
treatment. The PSE were empirically managed with older Anti-Epileptic Drugs
(AEDs) like Carbamazepine (CBZ), which is not without issues on side effect,
drug-drug interactions, and tolerability. Newer AEDs like levetiracetam (LEV)
have better safety and tolerability profiles, however there is limited clinical
evidence supporting its use in the treatment and prevention of PSE. This study
was therefore designed to identify determinants of PSE and compare
prophylactic and therapeutic effects of LEV and CBZ monotherapy.
The study was divided into three phases and carried out in three purposively
selected tertiary health institutions in South West Nigeria. The first phase
involved detailed review of records for socio-demographics, aetiology and
medication characteristics of 946 adults, aged ≥1 6, and attending epilepsy
clinics for a minimum period of 5 years using convenient sampling method. In
the second phase, 346 neuroimage confirmed stroke patients who consented
were recruited and followed up for 24 months. Post Stroke Outcome (PSO)
such as severity, functional outcome, cognition and epileptiform pattern were
assessed using National Institute of Health Stroke Scale (NIHSS), Modified
Ranking Scale (MRS), Cognitive Screening Instrument for Dementia (CSID), and
Electroencephalography (EEG), respectively. Development of PSE, Mortality
Rate (MR) and determinants of PSE were evaluated. Those that developed
seizures were randomised into AED groups and followed up for 1 2 months and
PSO evaluated. The third phase recruited 240 neuroimage confirmed stroke
patients with no prior seizure history and randomly divided into Prophylactic
Group (PG) [80 each of LEV and CBZ] and Non-Prophylactic Group (NPG). The
Lev (250mg) and CBZ (200mg) were administered twice daily and evaluated
for PSO. Data were analysed using descriptive statistics, Chi square, and
independent student’s t test at α0.05.
The records showed that majority of the patients had idiopathic (60.1 %) and
structural epilepsy (24.9%), with stroke being the commonest. Two hundred
and ninety-four 294(31 .1 %) were not on AED and 51 5(79.0%) of those on AEDs
used CBZ. Twenty-seven percent (27%) developed PSE and identified
determinants of PSE were severe stroke (p0.01 0), diabetes mellitus (p0.002),
cortical involvement (p0.01 6), insomnia (p0.009) and epileptiform pattern
(p0.000). Comparing CBZ with LEV groups among PSE, PSO showed higher
MR [21 (45.7%) versus 1 1 (23.9%), p0.029], poor outcome on MRS [28(63.6%)
versus 1 7(40.5%), p0.032], severe NIHSS [26(56.5%) versus 1 3(28.3%), p0.006]
and impaired cognition on CSID [20(43.5%) versus 1 6(34.8%), p0.08],
respectively. In phase 3, 1 7(1 0.6%) of PG [1 0(1 2.8%) CBZ versus LEV 7(8.8%)]
compared to 1 7(21 .3%) of NPG developed seizures. There was higher MR
[22(1 3.7%) versus 34(42.5%), p0.029], poor outcome on MRS [(47(58.8%)
versus 59(36.9%), p0.001 )], and CSID score (53.39±26.1 9 versus 36.37±34.06,vii
p0.001 ) in NPG compared with PG.
Stroke severity, cortical involvement, epileptiform pattern and background
diabetes mellitus were identified as predictors of post stroke epilepsy.
Levetiracetam exhibited better therapeutic effect than carbamazepine for
prophylaxis and treatment of post stroke epilepsy. |
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