신경과, 신경외과 의사를 대상으로 한 뇌졸중 환자에서 항경련제 사용에 대한 설문조사

Abstract

Background: Seizures occur in 2-20% of stroke patients. Recent studies have reported that post-stroke seizures areassociated with poorer functional outcomesand higher mortality. However there are no official guidelines on how to useantiepileptic drugs (AEDs) in stroke-related seizures. In this study we surveyed neurologists and neurosurgeons andcompared the responses of subgroups categorized by department, specialty and workplace discrimination using aquestionnaire containing questions concerning the present tendency to use AEDs in stroke patients.Methods: 256 neurologists and neurosurgeons participated in the survey. The research instrument was a questionnairecomprising 9 parts and 30 questions. The questions concerned stroke mechanism, the prophylactic use of AEDs, and thechoice of AED in early and late onset post-stroke seizures.Results: Tendencies to use prophylactic AEDs in stroke differed depending on specialty and workplace(neurologist vs.neurosurgeon; 17.8% vs. 83.1%, p<0.001, hospital vs. university staff; 46.2% vs. 28.4%, p=0.05). The most commonly usedprophylactic AEDs were valproic acid (75%) and levetiracetam (60%). Carbamazepine was the most commonly used AEDand phenytoin and phenobarbital were still used in all subgroups to treat post-stroke seizures.Conclusions: There are significant differences between neurologists (17.8%) and neurosurgeons (83.1%) in the use ofprophylactic AEDs after stroke. Valproic acid and levetiracetam are considered first-line prophylactic AEDs byneurosurgeon. Phenytoin and phenobarbital are still used in post-stroke seizure although they have been reported tohave an adverse influence on motor recovery. We suggest that proper guidelines should be established for the use ofAEDs in stroke-related seizures.