Medication use in poststroke epilepsy: A descriptive study on switching of antiepileptic drug treatment

• Published in: Epilepsy & behavior Vol. 104; no. Pt B; p. 106434
• Main Authors: Bekelaar, K., van Tuijl, J.H., van Raak, E.P.M., van Oostenbrugge, R.J., Aldenkamp, A.P., Rouhl, R.P.W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2020
• Subjects: Adult; Aged; Anticonvulsants - therapeutic use; Antiepileptic drugs; Drug Substitution - methods; Drug Substitution - trends; Drug-Related Side Effects and Adverse Reactions - drug therapy; Drug-Related Side Effects and Adverse Reactions - etiology; Epilepsy; Epilepsy - drug therapy; Epilepsy - etiology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Poststroke epilepsy; Prospective Studies; Retrospective Studies; Stroke - complications; Stroke - drug therapy; Treatment Outcome; Poststroke epilepsy; Antiepileptic drugs; Epilepsy
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2019.07.035

Currently, as evidence-based guidelines are lacking, in patients with poststroke epilepsy (PSE), the choice of the first antiepileptic drug (AED) is left over to shared decision by the treating physician and patient. Although, it is not uncommon that patients with PSE subsequently switch their first prescribed AED to another AED, reasons for those switches are not reported yet. In the present study, we therefore assessed the reasons for switching the first prescribed AED in patients with PSE. We gathered a hospital-based case series of 53 adult patients with poststroke epilepsy and assessed the use of AEDs, comedication, and the reasons for switches between AEDs during treatment. We also determined the daily drug dose (DDD) at the switching moment. During a median follow-up of 62 months (Interquartile range [IQR] 69 months), 21 patients (40%) switched their first prescribed AED. Seven patients switched AED at least once because of ineffectivity only or a combination of ineffectivity and side effects, whereas 14 patients switched AED at least once because of side effects only. The DDD was significantly (p < 0.001) higher in case of medication switches due to ineffectivity (median 1.20, IQR 0.33) compared to switching due to side effects (median 0.67, IQR 0.07). There was no difference in the use of comedication between the group that switched because of ineffectivity compared to the group that switched because of side effects. In our case series, up to 40% of patients with epilepsy after stroke needed to switch their first prescribed AED, mostly because of side effects in lower dosage ranges. •It is unknown why patients switch their antiepileptic drugs in poststroke epilepsy.•We found that 40% of patients needed to switch.•13% of patients switched because of ineffectivity of the first prescribed AED.•Dosages at the time of switching were higher in case of ineffectivity than in case of side effects.