Abstract Details

Title Anti-seizure Medication Use and Outcomes in Older Adults with Acute Traumatic Brain Injury

Topic Neuro Trauma and Critical Care

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 1-002

Objective

To determine antiseizure medication (ASM) prescription patterns and association with outcomes in older adults with traumatic brain injury (TBI).

Background

TBI in older adults is a public health concern and priority. Older adults have higher rates of TBI and post-injury complications including seizures. While current guidelines support the use of prophylactic ASMs for up to 7 days after severe TBI, the effectiveness of ASM use in older adults is yet to be determined resulting in practice variation. Older adults are also at highest risk for ASM adverse effects.

Design/Methods

This is a retrospective study of older adults (>65 years) admitted to a single center for ≥7 days following an acute TBI. The primary exposure was prophylactic ASM administration ≤ 7 (as supported by guidelines) vs >7 days. The primary outcome was death/severe disability at discharge (modified Rankin Scale of 5-6).

Results 188 patients were included. Median age was 82 years; 46% were female. Fall (90%) was the most common cause of TBI, followed by motor vehicle accidents (7%) and other causes (2%). 21 patients (11%) had clinical seizures on admission. 43 (23%) had dementia or cognitive concerns prior to admission. 13/94 (13%) patients that underwent electroencephalography monitoring had electrographic seizures. 52% received ASM for ≤ 7 days, 41% for > 7 days, and 7% received no ASMs. Levetiracetam was the only ASM prescribed. After adjusting for TBI severity, Charlson Comorbidity Index, seizures, and imaging findings, ASM administration for >7 days (compared with ≤7 days) although had higher odds of death/severe disability at discharge, the finding did not reach statistical significance (adjusted OR = 2.0 [95% CI 0.55-7.13]).

Conclusions

ASMs were frequently continued for >7 days with no significant association with short-term outcomes. Larger comparative studies are indicated to determine both short and long-term risk-benefit trade-offs of ASM prophylaxis in older adults with TBI.

Authors/Disclosures
Poojith Nuthalapati, MD PRESENTER	Mr. Nuthalapati has nothing to disclose.
Muhammad Aemaz Ur Rehman, MD	Dr. Aemaz Ur Rehman has nothing to disclose.
Muhammad Saim	Mr. Saim has nothing to disclose.
Marta Fernandes (Massachusetts General Hospital)	Marta Fernandes has nothing to disclose.
Brian Edlow, MD	Dr. Edlow has received research support from NIH.
Lidia Maria V. Moura, MD, PhD, MPH, FAAN (Massachusetts General Hospital)	Dr. Moura has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Moura has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. The institution of Dr. Moura has received research support from Centers for Diseases Control and Prevention (CDC SIP20-007) . The institution of Dr. Moura has received research support from Epilepsy Foundation of America . The institution of Dr. Moura has received research support from NIH - NIA and NINDS. Dr. Moura has received personal compensation in the range of $50,000-$99,999 for serving as a Expert Advisor with Epilepsy Foundation .
Sahar Zafar, MD	Dr. Zafar 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 Springer. Dr. Zafar has received research support from NIH. Dr. Zafar has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker for a lecture with Marinus.

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