Prophylactic Seizure Medication and Health-Related Quality of Life After Intracerebral Hemorrhage.

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0355501 Publication Model: Print Cited Medium: Internet ISSN: 1530-0293 (Electronic) Linking ISSN: 00903493 NLM ISO Abbreviation: Crit Care Med Subsets: MEDLINE

Publication: Philadelphia, PA : Lippincott Williams & Wilkins
Original Publication: New York, Kolen.

Quality of Life*; Anticonvulsants/*therapeutic use ; Cerebral Hemorrhage/*complications ; Levetiracetam/*therapeutic use ; Seizures/*etiology ; Seizures/*prevention & control; Anticonvulsants/adverse effects ; Cognition/drug effects ; Cognitive Dysfunction/chemically induced ; Female ; Humans ; Levetiracetam/adverse effects ; Male ; Middle Aged ; Prospective Studies

Objectives: Prophylactic levetiracetam is currently used in ~40% of patients with intracerebral hemorrhage, and the potential impact of levetircetam on health-related quality of life is unknown. We tested the hypothesis that prophylactic levetiracetam is independently associated with differences in cognitive function health-related quality of life.
Design: Patients with intracerebral hemorrhage were enrolled in a prospective cohort study. We performed mixed models for T-scores of health-related quality of life, referenced to the U.S. population at 50 ± 10, accounting for severity of injury and time to follow-up.
Setting: Academic medical center.
Patients: One-hundred forty-two survivors of intracerebral hemorrhage.
Interventions: None.
Measurements and Main Results: T-scores of Neuro-Quality of Life Cognitive Function v2.0 was the primary outcome, whereas Neuro-Quality of Life Mobility v1.0 and modified Rankin Scale (a global functional scale) were secondary measures. We prospectively documented if prophylactic levetiracetam was administered and retrieved administration data from the electronic health record. Patients who received prophylactic levetiracetam had worse cognitive function health-related quality of life (T-score 5.1 points lower; p = 0.01) after adjustment for age (p = 0.3), National Institutes of Health Stroke Scale (p < 0.000001), lobar hematoma (p = 0.9), and time of assessment; statistical models controlling for prophylactic levetiracetam and the Intracerebral Hemorrhage Score, a global measure of intracerebral hemorrhage severity, yielded similar results. Lower T-scores of cognitive function health-related quality of life at 3 months were correlated with more total levetiracetam dosage (p = 0.01) and more administered doses of levetiracetam in the hospital (p = 0.03). Patients who received prophylactic levetiracetam were more likely to have a lobar hematoma (27/38 vs 19/104; p < 0.001), undergo electroencephalography monitoring (15/38 vs 21/104; p = 0.02), but not more likely to have clinical seizures (4/38 vs 7/104; p = 0.5). Levetiracetam was not independently associated with the modified Rankin Scale scores or mobility health-related quality of life (p > 0.1).
Conclusions: Prophylactic levetiracetam was independently associated with lower cognitive function health-related quality of life at follow-up after intracerebral hemorrhage.

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L30 NS098427 United States NS NINDS NIH HHS; UL1 TR000150 United States TR NCATS NIH HHS; K18 HS023437 United States HS AHRQ HHS; L30 NS080176 United States NS NINDS NIH HHS; UL1 TR001422 United States TR NCATS NIH HHS; KL2 TR001424 United States TR NCATS NIH HHS; K23 NS092975 United States NS NINDS NIH HHS; U54 AR057951 United States AR NIAMS NIH HHS

0 (Anticonvulsants)
44YRR34555 (Levetiracetam)

Date Created: 20180621 Date Completed: 20190926 Latest Revision: 20240610

20240610

PMC6095719

10.1097/CCM.0000000000003272

29923930