1250. Use of Antiepileptic Drugs in Subarachnoid Hemorrhage (ALIBI)

Authors: Georgios Maragkos; Adam Dmytriw, MD, MSc; Jeffrey Zuccato, MD; Jeffrey Singh, MD, MSc; Elizabeth Wilcox, MD, MPH; Sacha Schweikert, MD (Brookline, MA)

Introduction:

There is controversy regarding antiepileptic drug (AED) prophylaxis in patients with subarachnoid hemorrhage (SAH). The aim of this study was to identify factors associated with current practices of prescribing AED prophylaxis, risk factors predictive of clinical seizures, and possible discrepancies.

Methods:

A retrospective chart review of all consecutive patients with SAH admitted between 2012 and 2014 at a single ICU was conducted. Clinical and imaging characteristics were collected. The primary outcome was prescription of AED prophylaxis and the secondary outcome was clinical seizure activity during hospitalization. Data were compared using appropriate statistical tests, with P values at 0.05 for significance. Factors found significant on univariate analysis were fitted into multivariate regression models.

Results:

Sixty-eight patients were included in the analysis. Mean age was 62±12, and 42.6% of patients were male. Of these, 21 patients (30.9%) received AED prophylactically, while 18 (26.5%) had reported seizures at some point during hospitalization. For the primary outcome, female gender and presence of midline shift were significantly associated or approached significance with AED prophylaxis in univariate analysis (P = 0.036 and P = 0.062 respectively), but only female gender was independently significant in multivariate analysis. For the secondary outcome, midline shift, subdural hematoma and WFNS grade were associated with seizures in univariate analysis (P = 0.006, P = 0.077 and P = 0.081 respectively), but only midline shift was an independent predictor on multivariate analysis.

Conclusion:

While there seems to be an association of midline shift with seizure activity, AED prophylaxis was not informed by this risk factor. Conversely, female SAH patients were more likely to receive AEDs, but had no additional danger of seizures. This result delineates the controversy in AED prescribing practices in SAH, and larger studies are needed to identify the risk factors for seizures and assist in informed decision-making.