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

K. Bekelaar, J.H. van Tuijl, E.P.M. van Raak, R.J. van Oostenbrugge, A.P. Aldenkamp, R.P.W. Rouhl (Corresponding author)

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Abstract

Objective: 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. Method: 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. Results: 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. Conclusion: 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.

Original languageEnglish
Article number106434
Number of pages3
JournalEpilepsy and Behavior
Volume104
Early online date31 Aug 2019
DOIs
Publication statusPublished - 1 Mar 2020

Keywords

  • Antiepileptic drugs
  • Epilepsy
  • Poststroke epilepsy

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