Duration of Seizure Prophylaxis in Focal Circumscribed Intracranial Infections
Abstract number :
1.229
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2021
Submission ID :
1826315
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:53 AM
Authors :
Sujana Madathil, MBBS, MHSc - University of Iowa; Brian Dlouhy, MD - Assistant Professor, Neurosurgery, University of Iowa; Michael Ciliberto, MD - Associate Professor, Pediatrics, University of Iowa
Rationale: Focal circumscribed intracranial infections have been associated with increased risk of seizures and subsequent epilepsy in 30-32% of cases1,2. There are no clear existing guidelines on the type or duration of prophylaxis of seizures resulting from these infections. We looked at the duration and type of prophylaxis and treatment of seizures related to focal intracranial infections in patients of all age groups at a single institution from 2004-2021.
Methods: We conducted a retrospective electronic medical record review of all identified patients with focal intracranial infections including intraparenchymal abscess, subdural empyema, and epidural abscess. Patients were identified using a data search tool, TriNetX, a global federated health research network. Information regarding location of infection, incidence of seizures, type and duration of treatment and prophylaxis were collected.
Results: There were 213 patients (64% male) with focal intracranial infections with intraparenchymal abscess being the most common type (71%). Independent bilateral frontal areas were the most common location of the intraparenchymal infections (72%). Patients with epidural abscess were less likely to develop seizures (8%) compared to patients with intraparenchymal (40%; p=0.003) or subdural empyema (39%; p< 0.01). Seizure was the presenting symptoms in only 18% of patients. 30% of patients presenting with seizures had abnormal EEG at diagnosis although only 33% had an EEG. The cumulative probability of seizure at abscess diagnosis was 24% (95% CI 19,30) which increased to 39% (95% CI 32, 47) within 24 months of diagnosis. Of the 213 patients, 25 (11%) had both prophylaxis and treatment as they had seizure while they were receiving the prophylaxis. 98 (46%) had only prophylaxis and 49 (23%) had only treatment. 40 (19%) did not receive any prophylaxis or treatment. Of the 123 with prophylaxis, 25 transitioned to treatment (20.3%). This is significantly lower compared to 49 of 89 (55%) of those without prophylaxis. The median duration of seizure prophylaxis and treatment were 2 months and 32 months, respectively. The anti-seizure medication of choice was levetiracetam (97%). There was no association of occurrence of seizure with age or immunosuppression.
Clinical Epilepsy