Nielsen Victoria M, Klompas Michael, Manjourides Justin, Smith Louisa H
Department of Public Health and Health Sciences, Northeastern University, Boston, Massachusetts.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
JAMA Netw Open. 2025 Aug 1;8(8):e2524557. doi: 10.1001/jamanetworkopen.2025.24557.
Epilepsy is a common complication of brain abscess. However, the effectiveness of antiseizure medications (ASMs) in preventing epilepsy in brain abscess survivors is unknown.
To assess whether the initiation of ASMs is associated with a reduced risk of epilepsy.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study conducted a target trial emulation using US commercial insurance claims data from October 1, 2016, to June 30, 2022, and followed up patients for 180 days. The study population was restricted to those with a diagnosis of brain abscess using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes associated with an acute care visit. Only patients aged 18 years or older at the time of the brain abscess with at least 1 year of prior enrollment were included. Statistical analysis was performed from May to December 2024.
A priori selected study ASMs were levetiracetam, valproate, and phenytoin. A clone-censor-weight approach was used to compare the initiation of ASMs within a 45-day grace period (treatment arm) with no initiation of ASMs (control arm). Inverse probability weights were used to control for treatment selection.
Study outcome was a diagnosis of epilepsy or seizure (with ICD-10-CM code) occurring 15 days or more after the index date. Weighted Kaplan-Meier models were fitted to estimate risk differences (RDs) at 90, 135, and 180 days accompanied by nonparametric bootstrapped 95% CIs. Sensitivity analyses were conducted to assess internal threats to validity.
Among the 572 patients included, the mean (SD) age was 61.5 (16.6) years and 353 (61.7%) were male. Of those in the treatment arm, 83 (88.3%) initiated ASMs within the first 30 days. Overall, 129 patients (22.5%) developed epilepsy during follow-up. There was no statistically significant risk difference in the probability of epilepsy incidence at each follow-up time point (RD at 90 days, -0.02% [95% CI, -4.9% to 4.8%]; RD at 135 days, 1.9% [95% CI, -5.0% to 8.5%]; RD at 180 days, 3.5% [95% CI, -4.4% to 10.8%]). Sensitivity analyses agreed with the primary findings.
In this cohort study of brain abscess survivors, initiation of ASMs was not associated with a reduced risk of epilepsy. Future studies should replicate the findings and consider alternative treatment protocols.
癫痫是脑脓肿的常见并发症。然而，抗癫痫药物（ASMs）在预防脑脓肿幸存者癫痫发作方面的有效性尚不清楚。
评估启动ASMs是否与降低癫痫风险相关。
设计、设置和参与者：这项回顾性队列研究使用2016年10月1日至2022年6月30日的美国商业保险理赔数据进行目标试验模拟，并对患者进行了180天的随访。研究人群仅限于那些使用与急性护理就诊相关的国际疾病分类第十版临床修订本（ICD-10-CM）编码诊断为脑脓肿的患者。仅纳入脑脓肿发生时年龄在18岁及以上且至少提前1年入组的患者。统计分析于2024年5月至12月进行。
预先选定的研究ASMs为左乙拉西坦、丙戊酸盐和苯妥英钠。采用克隆审查权重法比较45天宽限期内启动ASMs的患者（治疗组）与未启动ASMs的患者（对照组）。使用逆概率权重来控制治疗选择。
研究结局为在索引日期后15天或更长时间发生的癫痫或癫痫发作诊断（使用ICD-10-CM编码）。拟合加权Kaplan-Meier模型以估计90天、135天和180天时的风险差异（RDs），并伴有非参数自举95%置信区间。进行敏感性分析以评估内部有效性威胁。
在纳入的572例患者中，平均（标准差）年龄为61.5（16.6）岁，353例（61.7%）为男性。在治疗组中，83例（88.3%）在头30天内启动了ASMs。总体而言，129例患者（22.5%）在随访期间发生了癫痫。在每个随访时间点，癫痫发病率的概率没有统计学上的显著风险差异（90天时的RD为-0.02%[95%置信区间，-4.9%至4.8%]；135天时的RD为1.9%[95%置信区间，-5.0%至8.5%]；180天时的RD为3.5%[95%置信区间，-4.4%至10.8%]）。敏感性分析与主要发现一致。
在这项针对脑脓肿幸存者的队列研究中，启动ASMs与降低癫痫风险无关。未来的研究应重复这些发现并考虑替代治疗方案。
