Comparative risk of major health events among individuals prescribed different antiseizure medications following ischemic stroke

IF 6.6 1区医学 Q1 CLINICAL NEUROLOGY Epilepsia Pub Date : 2025-03-11 DOI:10.1111/epi.18336

Stella Jung-Hyun Kim, Clara Marquina, Emma Foster, J. Simon Bell, Jenni Ilomäki

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Abstract

Objective

The aim of this study was to compare the risk of seizure, recurrent stroke, fall or fracture, and mortality in individuals prescribed different antiseizure medications (ASMs) following an ischemic stroke.

Methods

We identified all patients admitted to a Victorian public or private hospital with a principal diagnosis of an incident ischemic stroke between 2013 and 2017 and dispensed an ASM within 12 months of discharge. Cox proportional hazards regression was used to estimate the risk of cause-specific rehospitalization or emergency department visits (seizure, fall or fracture, recurrent stroke) and all-cause mortality over a 2-year period. Inverse probability of treatment weighting was applied to each model to adjust for baseline covariates.

Results

Of 19 601 individuals hospitalized for incident ischemic stroke, 897 initiated ASM treatment within 12 months. More than three quarters were initiated on a non-enzyme-inducing ASM (78.0%). Levetiracetam (41.9%), valproate (28.4%), and carbamazepine (11.4%) were commonly dispensed initial ASMs. Non-enzyme-inducing ASMs demonstrated similar risk of seizure (hazard ratio [HR] = .93, 95% confidence interval [CI] = .63–1.37), fall or fracture (HR = 1.47, 95% CI = .92–2.34), stroke (HR = .83; 95% CI = .52–1.33), and mortality (HR = .96; 95% CI = .69–1.32) compared to enzyme-inducing ASMs. However, when valproate was grouped as a separate class, non-enzyme-inducing ASMs (HR = 1.67, 95% CI = 1.04–2.71) showed higher risk of fall or fracture compared to enzyme-inducing ASMs.

Significance

At a population level, ASMs of different types showed no significant differences in the risk of hospitalization or emergency department presentation for seizure, fall or fracture, stroke, and mortality within 2 years of an incident stroke presentation, suggesting similar short-term health outcomes in a real-world setting. Future research should investigate decision-making around ASM choice for stroke survivors and examine the impact of long-term ASM exposure on health outcomes.

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缺血性卒中后服用不同抗癫痫药物的个体间主要健康事件的比较风险

目的：本研究的目的是比较缺血性卒中后服用不同抗癫痫药物（asm）的患者癫痫发作、卒中复发、跌倒或骨折的风险和死亡率。方法：我们确定了2013年至2017年期间在维多利亚州公立或私立医院住院的所有主要诊断为偶发性缺血性卒中的患者，并在出院后12个月内分配了ASM。使用Cox比例风险回归来估计2年内因特异性再住院或急诊就诊（癫痫发作、跌倒或骨折、复发性卒中）和全因死亡率的风险。对每个模型应用处理加权逆概率来调整基线协变量。结果：在19 601例缺血性卒中住院患者中，897例在12个月内开始了ASM治疗。超过四分之三的患者（78.0%）开始使用非酶诱导的ASM。左乙拉西坦（41.9%）、丙戊酸酯（28.4%）和卡马西平（11.4%）是常用的初始抗炎药物。非酶诱导的asm表现出类似的癫痫发作（风险比[HR] = 0.93, 95%可信区间[CI] = 0.63 -1.37）、跌倒或骨折（HR = 1.47, 95% CI = 0.92 -2.34）、中风(HR = 0.83；95% CI = 0.52 -1.33)，死亡率(HR = 0.96；95% CI = 0.69 -1.32)。然而，当丙戊酸酯作为一个单独的类别分组时，非酶诱导性asm （HR = 1.67, 95% CI = 1.04-2.71）比酶诱导性asm表现出更高的跌倒或骨折风险。意义：在人群水平上，不同类型的asm在癫痫发作、跌倒或骨折、中风的住院或急诊科表现的风险以及意外中风表现后2年内的死亡率方面没有显着差异，这表明在现实世界中，短期健康结果相似。未来的研究应该调查卒中幸存者选择ASM的决策，并检查长期ASM暴露对健康结果的影响。

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来源期刊

Epilepsia 医学-临床神经学

CiteScore

10.90

自引率

10.70%

发文量

319

审稿时长

2-4 weeks

期刊介绍： Epilepsia is the leading, authoritative source for innovative clinical and basic science research for all aspects of epilepsy and seizures. In addition, Epilepsia publishes critical reviews, opinion pieces, and guidelines that foster understanding and aim to improve the diagnosis and treatment of people with seizures and epilepsy.