Abstract Details

Title Antiseizure Medications in Post-stroke Seizures: A Systematic Review and Network Meta-analysis

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P8 - Poster Session 8 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-012

Objective To determine outcomes associated with antiseizure medication (ASM) in people with post-stroke seizure (PSS).

Background It is unclear which ASMs are most effective in treating PSS.

Design/Methods We systematically searched electronic databases for studies in PSS patients on ASM. Our outcomes were mortality, adverse events, seizure recurrence, and ASM discontinuation. We assessed risk-of-bias using ROB-2 and ROBINS-I. Using levetiracetam as the common comparator, we conducted frequentist network meta-analyses and validated our results using a Bayesian approach. We report pooled odds ratio (OR) and 95% confidence intervals (CI) and ranked treatment benefits using p-scores. (PROSPERO CRD42022363844)

Results Our search yielded 15 studies (3 randomized, 12 non-randomized, N=18676, 60% male, mean age 69 years) comparing 13 ASMs. Three studies had moderate, and 12 had high risk-of-bias. Using frequentist approach, compared to levetiracetam, phenytoin (OR 8.3; CI 5.7-11.9), valproic acid (VPA) (4.7; 3.6-6.3), oxcarbazepine (3.3; 1.7-6.5), and carbamazepine (2.1; 1.7-2.7) were associated with greater mortality. Phenytoin (5.2; 1.2-22.9) and carbamazepine (1.9; 1.0-3.5) were associated with greater adverse events. Carbamazepine (1.8; 1.5-2.2), VPA (1.3; 1.0-1.6), and phenytoin (1.9; 1.4-2.8) had greater ASM discontinuation rates. Despite ASM use, 37.4% (23.2-52.8%) (10 studies; N=4783) had a recurrent seizure(s). Carbamazepine (3.0; 1.7-5.3), VPA (4.2; 2.1-8.3), lamotrigine+VPA (5.8; 2.1-16.1), and phenytoin (7.3; 3.7-14.5) were associated with greater seizure recurrence and potential confounding by indication. P-scores indicated lowest mortality with levetiracetam, fewest adverse events and drug discontinuation with lamotrigine, and fewest seizure recurrence with eslicarbazepine. Findings were consistent using the Bayesian approach.

Conclusions Levetiracetam and lamotrigine may be preferred ASMs for PSS. Despite ASM use, seizure recurrence rate remains high. Cautious interpretation is necessary due to moderate-to-high bias risk in reported data and potential confounding by indication. An analysis of methodically collected prospective multicentric ASM data in PSS patients is critically needed to determine safety, efficacy, and the mechanisms of drug resistance.

Authors/Disclosures
Ethan Y. Wang (Yale School of Medicine) PRESENTER	Mr. Wang has nothing to disclose.
Shubham Misra, PhD (Yale University)	Dr. Misra has nothing to disclose.
Jesse Dawson	Jesse Dawson, 12284 has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra Zeneca. Jesse Dawson, 12284 has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer. Jesse Dawson, 12284 has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pfizer. Jesse Dawson, 12284 has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS. Jesse Dawson, 12284 has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Boeringher Ingelheim. Jesse Dawson, 12284 has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic.
Patrick Kwan	Patrick Kwan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EDUCOM SPA. Patrick Kwan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai. Patrick Kwan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB. The institution of Patrick Kwan has received research support from UCB. The institution of Patrick Kwan has received research support from Eisai.
Scott E. Kasner, MD, FAAN (University of Pennsylvania)	Dr. Kasner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Kasner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Kasner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Javelin. Dr. Kasner 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 UpToDate. The institution of Dr. Kasner has received research support from WL Gore. The institution of Dr. Kasner has received research support from DiaMedica. The institution of Dr. Kasner has received research support from Bayer.
James C. Grotta, MD, FAAN (Memorial Hermann Hospital Life Flight)	Dr. Grotta has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Frazer Ltd. Dr. Grotta has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Haemonetics. Dr. Grotta has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acticor. Dr. Grotta has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Prolong Pharma. Dr. Grotta has received publishing royalties from a publication relating to health care. Dr. Grotta has received publishing royalties from a publication relating to health care.
David Larsson	No disclosure on file
Tomotaka Tanaka (National Cerebral and Cardiovascular Center)	No disclosure on file
Hitten Zaveri	No disclosure on file
Selena Wang	No disclosure on file
Erum Khan (B.J.Medical College,Ahmedabad)	Ms. Khan has nothing to disclose.
Melissa Funaro (Yale)	Melissa Funaro has nothing to disclose.
SRAVAN PERLA (Yale University)	No disclosure on file
Priya Dev	No disclosure on file
Taimoor Hussain (Yale University)	No disclosure on file
David S. Liebeskind, MD, FAAN (Neurovascular Imaging Research Core at UCLA)	Dr. Liebeskind has received research support from Cerenovus. Dr. Liebeskind has received research support from Genentech . Dr. Liebeskind has received research support from Medtronic. Dr. Liebeskind has received research support from Stryker.
Clarissa L. Yasuda, MD, PhD (University of Campinas)	Prof. Yasuda has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for LIBBS. Prof. Yasuda has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ABBOTT. Prof. Yasuda has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for LIBBS.
Amr Elshahat, MD, MBBS (Yale university)	Dr. Elshahat has nothing to disclose.
Gazala Hitawala, MD	Dr. Hitawala has nothing to disclose.
Rachel Kitagawa (Yale School of Medicine)	Ms. Kitagawa has nothing to disclose.
Abhishek Pathak, MD, MBBS, DM (Dept of Neurology)	Dr. Pathak has nothing to disclose.
Yize Zhao	No disclosure on file
Fabien Scalzo, PhD (Pepperdine)	Prof. Scalzo has nothing to disclose.
Masafumi Ihara, MD, PhD (National Cerebral and Cardiovascular Center)	Dr. Ihara has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Otsuka Pharmaceutical. Dr. Ihara has received research support from Panasonic. Dr. Ihara has received research support from GE Precision Healthcare LLC. Dr. Ihara has received research support from Kyosera. Dr. Ihara has received research support from Towa Corporation. The institution of Dr. Ihara has received research support from Pharmafoods.
Johan Zelano, MD (Sahlgrenska University Hospital)	Dr. Zelano has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley. The institution of Dr. Zelano has received research support from research foundations supporting Swedish neurological research. Dr. Zelano has received publishing royalties from a publication relating to health care. Dr. Zelano has received publishing royalties from a publication relating to health care. Dr. Zelano has received personal compensation in the range of $500-$4,999 for serving as a speaker at non-branded educational events in epilepsy with UCB and Eisai. Dr. Zelano has a non-compensated relationship as a member of the board with Swedish Epilepsy Society that is relevant to AAN interests or activities.
Katharina Stibrant Sunnerhagen (univ of Gothenburg)	No disclosure on file
Matthew WALTERS	No disclosure on file
Nathalie Jette, MD, MSc, FRCPC, FAAN (University of Calgary)	Dr. Jette has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ILAE Epilepsia. The institution of Dr. Jette has received research support from NIH. The institution of Dr. Jette has received research support from AES.
Terry Quinn (University of Glasgow)	No disclosure on file
Nishant K. Mishra, MD, MBBS, PhD, FESO (Yale University)	Dr. Mishra has nothing to disclose.

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