Phenytoin exposure is associated with functional and cognitive disability after subarachnoid hemorrhage

Andrew M. Naidech*, Kurt T. Kreiter, Nazli Janjua, Noeleen Ostapkovich, Augusto Parra, Christopher Commichau, E. Sander Connolly, Stephan A. Mayer, Brian Fred M. Fitzsimmons

*Corresponding author for this work

Research output: Contribution to journalArticle

208 Scopus citations

Abstract

Background and Purpose-Phenytoin (PHT) is routinely used for seizure prophylaxis after subarachnoid hemorrhage (SAH), but may adversely affect neurologic and cognitive recovery. Methods-We studied 527 SAH patients and calculated a "PHT burden" for each by multiplying the average serum level of PHT by the time in days between the first and last measurements, up to a maximum of 14 days from ictus. Functional outcome at 14 days and 3 months was measured with the modified Rankin scale, with poor functional outcome defined as dependence or worse (modified Rankin Scale ≥4). We assessed cognitive outcomes at 14 days and 3 months with the telephone interview for cognitive status. Results-PHT burden was associated with poor functional outcome at 14 days (OR, 1.5 per quartile; 95% CI, 1.3 to 1.8; P<0.001), although not at 3 months (P=0.09); the effect remained (OR, 1.6 per quartile; 95% CI, 1.2 to 2.1; P<0.001) after correction for admission Glasgow Coma Scale, fever, stroke, age, National Institutes of Health Stroke Scale ≥10, hydrocephalus, clinical vasospasm, and aneurysm rebleeding. Seizure in hospital (OR, 4.1; 95% CI, 1.5 to 11.1; P=0.002) was associated with functional disability in a univariate model only. Higher quartiles of PHT burden were associated with worse telephone interview for cognitive status scores at hospital discharge (P<0.001) and at 3 months (P=0.003). Conclusions-Among patients treated with PHT, burden of exposure to PHT predicts poor neurologic and cognitive outcome after SAH.

Original languageEnglish (US)
Pages (from-to)583-587
Number of pages5
JournalStroke
Volume36
Issue number3
DOIs
StatePublished - Mar 1 2005

Keywords

  • Critical care
  • Phenytoin
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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    Naidech, A. M., Kreiter, K. T., Janjua, N., Ostapkovich, N., Parra, A., Commichau, C., Connolly, E. S., Mayer, S. A., & Fitzsimmons, B. F. M. (2005). Phenytoin exposure is associated with functional and cognitive disability after subarachnoid hemorrhage. Stroke, 36(3), 583-587. https://doi.org/10.1161/01.STR.0000141936.36596.1e