Abstracts

Rationale:
Patients with post-stroke epilepsy (PSE) are at higher risk of death and recurrent stroke than other epilepsy populations. Some antiepileptic drugs (AEDs) have been reported to relate to a higher mortality or cardiovascular risk. We compared the impact of different AEDs on the risk of death and recurrent stroke in patients with PSE.
Method:
We identified all hospitalized patients (≥20 years) with a primary diagnosis of ischemic or hemorrhagic stroke from 2001 to 2012 using the National Health Insurance Research Database in Taiwan. The PSE cohorts were defined as the stroke patients (1) who had no epilepsy and no AEDs use before the index stroke, and (2) who had epilepsy and AEDs use after 14 days from the stroke onset. The PSE patients receiving AED monotherapy were enrolled and were categorized into phenytoin, valproic acid, carbamazepine, and new AED groups. We employed the Cox regression model to estimate the unadjusted and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of death and recurrent stroke within 5 years across all groups, using the new AED group as the reference.
Results:
Of 6962 PSE patients using AED monotherapy, 3917 (56%) were on phenytoin, 1623 (23%) on valproic acid, 457 (7%) on carbamazepine, and 965 (14%) on new AEDs. After adjusting for confounders, compared with new AED users, phenytoin users had a higher risk of death in 5 years (HR: 1.64; 95% CI: 1.06-2.55). On the other hand, all AED groups showed a similar risk of recurrent stroke.
Conclusion:
Among PSE patients on first-line monotherapy, compared to other AEDs, use of phenytoin was associated with a higher risk of death in 5 years.
Funding:
:This work was supported by Chang Gung Memorial Hospital, Taiwan, grant number CFRPG6J0021