Anti-seizure medication use in hospitalized patients undergoing continuous EEG monitoring: A multicenter validation study
Natalie Erlich-Malona1, Neishay Ayub1, Hunter Rice2, Fernando Ibanhes1, Mohammad Haider2, Clio Rubinos3, Adithya Sivaraju4, Vineet Punia5, Sahar Zafar2, Monica Dhakar1
1Rhode Island Hospital, Brown University, 2Massachusetts General Hospital, Harvard University, 3University of North Carolina, Chapel Hill, 4Yale New Haven Medical Center, 5Cleveland Clinic
Objective:
To determine the predictors of ASM initiation and continuation after discharge in those undergoing cEEG.
Background:
Studies have shown that continuous EEG (cEEG) monitoring leads to an increase in the use of anti-seizure medications (ASM) in hospitalized patients. However, the factors leading to ASM use in these patients are not clearly identified.
Design/Methods:
We performed a retrospective study of hospitalized patients (age >18 years) who underwent cEEG between 07/01- 09/30/2021 at five centers. Patients with history of epilepsy were excluded. ASM initiation was defined as treatment for > 48 hours during hospitalization. ASM continuation was defined as ASM prescription at discharge. Multivariable logistic regression models were developed to determine predictors of ASM initiation and ASM continuation using data from three centers (derivation cohort). The models were validated externally using data from the remaining two centers (validation cohort).
Results:
Among 1,030 patients (median age 64, 55.1% females), 528 (51.2%) were started on ASM and 288 (27.9%) were discharged on ASMs. On multivariable analysis, predictors of ASM initiation included progressive brain injury (odds ratio [OR] 2.38; 95% CI 1.08-5.49), traumatic brain injury (TBI) (OR 6.38; 95% CI 2.39- 20.5), clinical acute symptomatic seizure (ASyS) (OR 16.5; 95% CI 9.11- 31.1), EEG ASyS (OR 30.3; 95% CI 8.18-15.7), and lateralized periodic discharges (LPDs) (OR 9.38; 95% CI 1.86-74.6). Area under the curve (AUC) of the model for ASM initiation was 0.90 and 0.85 in the derivation and validation cohorts, respectively. The predictors of ASM continuation included all of the above variables except TBI and LPDs, with AUC of 0.96 and 0.89 in the derivation and validation cohorts, respectively.
Conclusions:
Patients with progressive brain injury, clinical ASyS, or EEG ASyS are more likely to be treated and discharged on ASM. Further studies are required to study the impact of ASM use on outcomes.