Anti-Epileptic Medication Exposure Influences Functional Status in New Zealand Stroke Patients: A Retrospective Population-Level Study

Ailsa L McGregor; Md Rashedul Hoque; Sophia Nickel; Alesha J Smith; Mohammad Atiquzzaman

doi:10.1007/s40801-021-00280-5

Anti-Epileptic Medication Exposure Influences Functional Status in New Zealand Stroke Patients: A Retrospective Population-Level Study

Drugs Real World Outcomes. 2022 Mar;9(1):165-173. doi: 10.1007/s40801-021-00280-5. Epub 2021 Sep 27.

Authors

Ailsa L McGregor¹, Md Rashedul Hoque^{2

3}, Sophia Nickel⁴, Alesha J Smith⁴, Mohammad Atiquzzaman⁵

Affiliations

¹ School of Pharmacy, Division of Health Sciences, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. ailsa.mcgregor@otago.ac.nz.
² Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
³ Arthritis Research Canada, Vancouver, Canada.
⁴ School of Pharmacy, Division of Health Sciences, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
⁵ British Columbia Renal Agency, Vancouver, BC, Canada.

Abstract

Background: Patients who develop seizures after stroke have disproportionately poorer outcomes and increased mortality.

Objective: Our objective was to investigate whether exposure to anti-epileptic medications influenced long-term functional status after stroke.

Methods: We used linked health administrative data from a cohort of adult stroke patients in New Zealand. Demographics and prescription information were obtained from the National Minimum Dataset and Pharmaceutical Collection, respectively. Activities of daily living (ADL) scores for the same patients were obtained using the International Resident Assessment Instrument. Beta regression was used to investigate the relationship between anti-epileptic drug (AED) exposure and functional status.

Results: The study included 3606 patients with a single ischaemic stroke between 2012 and 2017. In total, 15% were dispensed an AED in the 3 months before or after stroke. The adjusted odds ratio (OR) for AED exposure was 1.29 (95% confidence interval [CI] 1.15-1.45). Overall AED exposure, categorical body mass index (BMI), ethnicity, length of hospital stay, and exposure to paracetamol, opioids, anti-psychotics, and anti-nausea medications were significantly associated with changes in the mean ADL score percentages. Considering the exposure timeframe, the ORs for AED exposure only after stroke and for exposure both before and after stroke were 1.52 (95% CI 1.31-1.78) and 1.09 (95% CI 0.93-1.27), respectively.

Conclusion: Stroke patients with AED exposure had greater odds of a higher ADL score, indicating a poorer long-term functional status than those unexposed to AEDs. The timeframe of exposure impacted on functional status, with patients exposed only after stroke having increased odds of higher ADL scores than those exposed both before and after stroke.