A Survey of the Use of Antiepileptic Drugs in Stroke Patients

J Korean Neurol Assoc > Volume 31(2); 2013 > Article

Journal of the Korean Neurological Association 2013;31(2): 101-107.

신경과, 신경외과 의사를 대상으로 한 뇌졸중 환자에서 항경련제 사용에 대한 설문조사

이진호, 조원호 박평강 김재형 장우영 김현영 김영서 김희태 김주한

한양대학교 의과대학 신경과학교실

A Survey of the Use of Antiepileptic Drugs in Stroke Patients

Jinho Lee

Department of Neurology, Hanyang University College of Medicine, Seoul, Korea

Abstract

Background: Seizures occur in 2-20% of stroke patients. Recent studies have reported that post-stroke seizures are associated with poorer functional outcomesand higher mortality. However there are no official guidelines on how to use antiepileptic drugs (AEDs)?in stroke-related seizures. In this study we surveyed neurologists and neurosurgeons and compared the responses of subgroups categorized by department, specialty and workplace discrimination using a questionnaire containing questions concerning the present tendency to use AEDs in stroke patients.
Methods: 256 neurologists and neurosurgeons participated in the survey. The research instrument was a questionnaire comprising 9 parts and 30 questions. The questions concerned stroke mechanism, the prophylactic use of AEDs, and the choice of AED in early and late onset post-stroke seizures.
Results: Tendencies to use prophylactic AEDs in stroke differed depending on?specialty and workplace(neurologist vs. neurosurgeon; 17.8% vs. 83.1%, p<0.001, hospital vs. university staff; 46.2% vs. 28.4%, p=0.05). The most commonly used prophylactic AEDs were valproic acid (75%) and levetiracetam (60%). Carbamazepine was the most commonly used AED and phenytoin and phenobarbital were still used in all subgroups to treat post-stroke seizures.
Conclusions: There are significant differences between neurologists (17.8%) and neurosurgeons (83.1%) in the use of prophylactic AEDs after stroke. Valproic acid and levetiracetam are considered first-line prophylactic AEDs by neurosurgeon. Phenytoin and phenobarbital are still used in post-stroke seizure although they have been reported to have an adverse influence on motor recovery. We suggest that proper guidelines should be established for the use of AEDs in stroke-related seizures. Key Words: Post-stroke seizure, Survey, Antiepileptic drug