Kim Stella Jung-Hyun, Marquina Clara, Foster Emma, Bell J Simon, Ilomäki Jenni
Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia.
School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
Epilepsia. 2025 Jun;66(6):1907-1918. doi: 10.1111/epi.18336. Epub 2025 Mar 11.
The aim of this study was to compare the risk of seizure, recurrent stroke, fall or fracture, and mortality in individuals prescribed different antiseizure medications (ASMs) following an ischemic stroke.
We identified all patients admitted to a Victorian public or private hospital with a principal diagnosis of an incident ischemic stroke between 2013 and 2017 and dispensed an ASM within 12 months of discharge. Cox proportional hazards regression was used to estimate the risk of cause-specific rehospitalization or emergency department visits (seizure, fall or fracture, recurrent stroke) and all-cause mortality over a 2-year period. Inverse probability of treatment weighting was applied to each model to adjust for baseline covariates.
Of 19 601 individuals hospitalized for incident ischemic stroke, 897 initiated ASM treatment within 12 months. More than three quarters were initiated on a non-enzyme-inducing ASM (78.0%). Levetiracetam (41.9%), valproate (28.4%), and carbamazepine (11.4%) were commonly dispensed initial ASMs. Non-enzyme-inducing ASMs demonstrated similar risk of seizure (hazard ratio [HR] = .93, 95% confidence interval [CI] = .63-1.37), fall or fracture (HR = 1.47, 95% CI = .92-2.34), stroke (HR = .83; 95% CI = .52-1.33), and mortality (HR = .96; 95% CI = .69-1.32) compared to enzyme-inducing ASMs. However, when valproate was grouped as a separate class, non-enzyme-inducing ASMs (HR = 1.67, 95% CI = 1.04-2.71) showed higher risk of fall or fracture compared to enzyme-inducing ASMs.
At a population level, ASMs of different types showed no significant differences in the risk of hospitalization or emergency department presentation for seizure, fall or fracture, stroke, and mortality within 2 years of an incident stroke presentation, suggesting similar short-term health outcomes in a real-world setting. Future research should investigate decision-making around ASM choice for stroke survivors and examine the impact of long-term ASM exposure on health outcomes.
本研究旨在比较缺血性卒中后使用不同抗癫痫药物（ASM）的个体发生癫痫、复发性卒中、跌倒或骨折以及死亡的风险。
我们确定了2013年至2017年间因首次缺血性卒中主要诊断入住维多利亚州公立或私立医院且出院后12个月内使用ASM的所有患者。采用Cox比例风险回归来估计2年内特定病因再住院或急诊就诊（癫痫、跌倒或骨折、复发性卒中）以及全因死亡率的风险。对每个模型应用治疗权重的逆概率来调整基线协变量。
在19601例因首次缺血性卒中住院的个体中，897例在12个月内开始使用ASM治疗。超过四分之三的患者开始使用非酶诱导型ASM（78.0%）。左乙拉西坦（41.9%）、丙戊酸盐（28.4%）和卡马西平（11.4%）是常用的初始ASM。与酶诱导型ASM相比，非酶诱导型ASM在癫痫发作风险（风险比[HR]=0.93，95%置信区间[CI]=0.63 - 1.37）、跌倒或骨折风险（HR = 1.47，95% CI = 0.92 - 2.34）、卒中风险（HR = 0.83；95% CI = 0.52 - 1.33）和死亡风险（HR = 0.96；95% CI = 0.69 - 1.32）方面表现相似。然而，当将丙戊酸盐单独归为一类时，与酶诱导型ASM相比，非酶诱导型ASM（HR = 1.67，95% CI = 1.04 - 2.71）显示出更高的跌倒或骨折风险。
在人群水平上，不同类型的ASM在首次卒中发作后2年内因癫痫、跌倒或骨折、卒中以及死亡而住院或急诊就诊的风险方面无显著差异，这表明在现实环境中短期健康结局相似。未来的研究应调查卒中幸存者选择ASM的决策过程，并研究长期使用ASM对健康结局的影响。
