Abstract Details

Title Oral Pregabalin As Adjunctive Treatment For Symptomatic Cyclic Seizures In Neurocritically Ill Patients

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 033

Objective To share our multi-center experience with Pregabalin (PGB) in neurocritically ill patients with refractory seizures.

Background PGB is an approved adjunctive treatment for focal epilepsy in adults. PGB lacks drug-drug interactions, has a favorable safety profile, and can be rapidly titrated. However, data remains limited regarding its use in the ICU setting.

Design/Methods Charts of 9 patients admitted to University of Florida Health Neuro ICU from 1/2018 ? 3/2019 and 7 patients admitted to Yale University Health Neuro ICU from 1/2017 - 3/2019 who were monitored on continuous electroencephalography (EEG) and received PGB for the management of refractory seizures were retrospectively reviewed. EEGs were independently reviewed by a board certified epileptologist or ICU-electroencephalographer. Demographics, anti-seizure drug (ASD) regimen, EEG data pre and post PGB administration were analyzed. Average and median seizure burden (cumulative duration of seizures in minutes per hour) were analyzed.

Results When comparing median seizure frequency 48 hours pre to 48 hours post PGB administration, there was a decrease of 1.52 seizures per hour (p=0.015). There was also a significant decrease of 1.79 in median seizure burden (p=0.039). Using segmented linear regression analysis we are able to further characterize the impact of PGB by analyzing immediate change in seizure burden and change per hour after PGB administration. There was an immediate decrease in the median seizure burden by 1.71 (p=0.014) and a decrease in median seizure burden per hour after PGB administration by 0.06 (p=0.028).

Conclusions In this series of neurocritically ill patients with symptomatic cyclic seizures and various underlying neurocritical conditions, addition of PGB lead to a significant reduction of seizure burden. PGB may represents a good compliment to other ASDs in this population given its pharmacokinetic profile, bioavailability, and limited drug-drug interactions. Future studies should include prospective PGB treatment protocols.

Authors/Disclosures
Mitesh Patel, MD (University of Florida, Department of Neurology) PRESENTER	Dr. Patel has nothing to disclose.
Zachary M. Newcomer, DO	Dr. Newcomer has nothing to disclose.
	No disclosure on file
RAKESH HARSHVADAN JADAV	RAKESH HARSHVADAN JADAV has nothing to disclose.
Michael Fong, MD (Westmead Hospital)	Dr. Fong has nothing to disclose.
Sotiris G. Mitropanopoulos, MD (Mayo Clinic)	Dr. Mitropanopoulos has nothing to disclose.
Maria J. Bruzzone, MD, FAAN (University of Florida)	Dr. Bruzzone has nothing to disclose.
Katharina M. Busl, MD, MS, FAAN (University of Florida)	Dr. Busl has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rissman Law. Dr. Busl has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Society of Critical Care Medicine. The institution of Dr. Busl has received research support from University of Florida Self Insurance Program. The institution of Dr. Busl has received research support from National Institutes of Health. Dr. Busl has a non-compensated relationship as a Board Member with Art in Medicine that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Associate Editor with Critical Care Explorations that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Editorial Board Member with Neurocritical Care that is relevant to AAN interests or activities.
Carolina B. Maciel, MD, MSCR, FAAN	Dr. Maciel has received research support from American Heart Association. Dr. Maciel has received research support from National Institute of Health.

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