![]() Two small randomized controlled trials in patients with PSE showed that lamotrigine and levetiracetam were effective for seizure control and were better tolerated compared to carbamazepine. International League Against Epilepsy had reported that carbamazepine, phenytoin, levetiracetam and zonisamide had level A evidence of efficacy for adults with focal seizures gabapentin and lamotrigine had level A evidence of efficacy for elderly adults with focal seizures. The choice of first-line ASMs in patients with PSE are diverse. Anti-seizure medications (ASMs) are often administered to prevent recurrent seizures in patients with PSE. Long term cumulative risk of post-stroke epilepsy (PSE) after a cerebrovascular event varies from 2 to 15 % according to different definitions of PSE, stroke types, and follow-up durations. ![]() ConclusionsĪmong patients with PSE on first-line monotherapy, compared to new ASMs, use of phenytoin was associated with a higher risk of death in 5 years.Ĭerebrovascular disease is a common underlying mechanism for late-onset epilepsy. On the other hand, all ASM groups showed a similar risk of new ischemic stroke in 5 years. After adjusting for confounders, compared with new ASM users, phenytoin users had a higher risk of death in 5 years (HR: 1.64 95 % CI: 1.06–2.55). Of 6962 patients with PSE using ASM monotherapy, 3917 (56 %) were on phenytoin, 1623 (23 %) on valproic acid, 457 (7 %) on carbamazepine, and 965 (14 %) on new ASMs. We employed the Cox regression model to estimate the unadjusted and adjusted hazard ratios (HRs) with 95 % confidence intervals (CIs) of death and new ischemic stroke within 5 years across all groups, using the new ASM group as the reference. The patients with PSE receiving ASM monotherapy were enrolled and were categorized into phenytoin, valproic acid, carbamazepine, and new ASM groups. ![]() The PSE cohort were defined as the stroke patients (1) who had no epilepsy and no ASMs use before the index stroke, and (2) who had epilepsy and ASMs use after 14 days from the stroke onset. 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. We aim to compare the effect of long-term anti-seizure medication (ASM) monotherapy on the risk of death and new ischemic stroke in patients with post-stroke epilepsy (PSE). ![]()
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