Department of Neurology, Northwestern University, Chicago, IL 60611, USA.
Stroke. 2009 Dec;40(12):3810-5. doi: 10.1161/STROKEAHA.109.559948. Epub 2009 Sep 24.
There are few data on the effectiveness and side effects of antiepileptic drug therapy after intracerebral hemorrhage. We tested the hypothesis that antiepileptic drug use is associated with more complications and worse outcome after intracerebral hemorrhage.
We prospectively enrolled 98 patients with intracerebral hemorrhage and recorded antiepileptic drug use as either prophylactic or therapeutic along with clinical characteristics. Antiepileptic drug administration and free phenytoin serum levels were retrieved from the electronic medical records. Patients with depressed mental status underwent continuous electroencephalographic monitoring. Outcomes were measured with the National Institutes of Health Stroke Scale and modified Rankin Scale at 14 days or discharge and the modified Rankin Scale at 28 days and 3 months. We constructed logistic regression models for poor outcome at 3 months with a forward conditional model.
Seven (7%) patients had a clinical seizure, 5 on the day of intracerebral hemorrhage. Phenytoin was associated with more fever (P=0.03), worse National Institutes of Health Stroke Scale at 14 days (23 [9 to 42] versus 11 [4 to 23], P=0.003), and worse modified Rankin Scale at 14 days, 28 days, and 3 months. In a forward conditional logistic regression model, phenytoin prophylaxis was associated with an increased risk of poor outcome (OR, 9.8; 1.4 to 68.6; P=0.02), entering after admission National Institutes of Health Stroke Scale and age. Excluding patients with a seizure did not change the results. Levetiracetam was not associated with demographics, seizures, complications, or outcomes.
Phenytoin was associated with more fever and worse outcomes after intracerebral hemorrhage.
颅内出血后抗癫痫药物治疗的有效性和副作用数据较少。我们检验了这样一个假设，即抗癫痫药物的使用与颅内出血后并发症更多和预后更差有关。
我们前瞻性纳入 98 例颅内出血患者，记录抗癫痫药物的使用情况，包括预防性和治疗性用药，并记录临床特征。从电子病历中获取抗癫痫药物的使用情况和游离苯妥英血清水平。精神状态低落的患者进行连续脑电图监测。采用国立卫生研究院卒中量表和改良 Rankin 量表在 14 天或出院时及 28 天和 3 个月时评估结局。我们构建了 3 个月预后不良的逻辑回归模型，采用向前条件模型。
7（7%）例患者出现临床癫痫发作，5 例发生在颅内出血当天。苯妥英与更多发热（P=0.03）、14 天时国立卫生研究院卒中量表评分更差（23[9 至 42]比 11[4 至 23]，P=0.003）和 14 天、28 天和 3 个月时改良 Rankin 量表评分更差有关。在前向条件逻辑回归模型中，苯妥英预防与不良预后风险增加相关（OR，9.8；1.4 至 68.6；P=0.02），进入模型的因素有入院时国立卫生研究院卒中量表评分和年龄。排除有癫痫发作的患者不会改变结果。左乙拉西坦与人口统计学、癫痫发作、并发症或结局无关。
苯妥英与颅内出血后发热和预后更差有关。
