Abstract
Background: Seizures are a morbid complication of intracerebral hemorrhage (ICH) and increase
the risk for herniation, status epilepticus, and worse patient outcomes. Prophylactic
levetiracetam is administered to approximately 40% of patients with ICH. It is unclear
which patients are consciously selected for treatment by physicians. We sought to
determine how patients are selected for treatment with prophylactic levetiracetam
after ICH. Methods: We administered an adaptive conjoint analysis using decision making software to an
NIH Stroke Trials Network Working Group. The adaptive conjoint analysis determines
the most influential attributes for making a decision in an iterative, algorithm-driven
process. We asked respondents which would most influence a decision to administer
prophylactic levetiracetam. The attributes and their levels were taken from published
phenotypes associated with prophylactic seizure medications and the likelihood of
seizures after ICH: hematoma location (lobar or basal ganglia), hematoma volume (<=10
mL or >10 mL), level of consciousness (Glasgow Coma Scale 5-12 or Glasgow Coma Scale
13-15), age (<65 or ≥65 years), and race (White or Caucasian or Black/African American).
The algorithm terminated when the attributes were ranked from most to least influential.
Results: The study sample included 27 respondents who completed the adaptive conjoint analysis
out of 42 who responded to the survey with a mean age of 43.4 ± 9.4 years. The attribute
with the greatest weight was hematoma location (30%), followed by reduced level of
consciousness (24%), hematoma volume (19%), race (14%), and age (13%). Ranks of attributes
were different (P < .001). Conclusions: The decision to administer prophylactic levetiracetam to patients with ICH is driven
by lobar hematoma location and depressed level of consciousness. Future research on
prophylactic seizure medication could focus on patients most likely to receive it.
Key Words
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Article info
Publication history
Published online: February 04, 2020
Accepted:
December 22,
2019
Received in revised form:
December 12,
2019
Received:
October 15,
2019
Footnotes
Funding: Dr. Naidech was supported, in part, by K18 NS023437 and R01 NS110779. Dr. Pinto was supported, in part, by the Foundation for Physical Therapy Research's Center on Health Services Training and Research Faculty Fellowship.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104628
Copyright
© 2019 Elsevier Inc. All rights reserved.
