Prophylactic Seizure Medication and Health-Related Quality of Life After Intracerebral Hemorrhage

Objectives: Prophylactic levetiracetam is currently used in ~40% of patients with intracerebral hemorrhage, and the potential impact of levetircetam on health-related quality of life is unknown. We tested the hypothesis that prophylactic levetiracetam is independently associated with differences in cognitive function health-related quality of life. Design: Patients with intracerebral hemorrhage were enrolled in a prospective cohort study. We performed mixed models for T-scores of health-related quality of life, referenced to the U.S. population at 50 ± 10, accounting for severity of injury and time to follow-up. Setting: Academic medical center. Patients: One-hundred forty-two survivors of intracerebral hemorrhage. Interventions: None. Measurements and Main Results: T-scores of Neuro-Quality of Life Cognitive Function v2.0 was the primary outcome, whereas Neuro-Quality of Life Mobility v1.0 and modified Rankin Scale (a global functional scale) were secondary measures. We prospectively documented if prophylactic levetiracetam was administered and retrieved administration data from the electronic health record. Patients who received prophylactic levetiracetam had worse cognitive function health-related quality of life (T-score 5.1 points lower; p = 0.01) after adjustment for age (p = 0.3), National Institutes of Health Stroke Scale (p 0.1). Conclusions: Prophylactic levetiracetam was independently associated with lower cognitive function health-related quality of life at follow-up after intracerebral hemorrhage. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Agency for Healthcare Research and Quality. Dr. Naidech designed and conceptualized the study, analyzed and interpreted the data, collected study data, drafted the article, and revised the article for important intellectual content. Dr. Naidech performed the statistical analysis under guidance from the National Institutes of Health Patient-Reported Outcomes Measurement Information System Statistical Center (to Dr. Cella, Ms. Beaumont). Ms. Beaumont oversaw the statistical analysis. Dr. Muldoon collected study data and revised the article for important intellectual content. Drs. Liotta, Potts, Jahromi, Cella, Prabhakaran, and Holl revised the article for important intellectual content. Dr. Maas designed and conceptualized the study and collected study data. Supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences grant UL1 TR000150. Dr. Naidech’s institution received funding from the Agency for Healthcare Research and Quality (AHRQ), and he received support for article research from the AHRQ (K18 HS023437) and the National Institutes of Health (NIH). Dr. Liotta’s institution received funding from NIH National Center for Advancing Translational Sciences grant KL2TR001424, and he received funding from the NIH Division of Loan Repayment grant L30NS098427. Dr. Maas’ institution received funding from the NIH grants K23 NS092975 and L30 NS080176 and a Dixon Translational Research Grant from the Northwestern Memorial Foundation, and he received support for article research from the NIH. Dr. Cella’s institution received funding from the National Institutes of Neurological Disorders and Stroke U01 NS 056 975 02 and NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases, U5 AR057951, and he received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: a-naidech@northwestern.edu Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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