{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T07:59:12Z","timestamp":1784447952185,"version":"3.55.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Epilepsy is a common complication of brain abscess. However, the effectiveness of antiseizure medications (ASMs) in preventing epilepsy in brain abscess survivors is unknown.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess whether the initiation of ASMs is associated with a reduced risk of epilepsy.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study conducted a target trial emulation using US commercial insurance claims data from October 1, 2016, to June 30, 2022, and followed up patients for 180 days. The study population was restricted to those with a diagnosis of brain abscess using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification<\/jats:italic> (ICD-10-CM<\/jats:italic>) codes associated with an acute care visit. Only patients aged 18 years or older at the time of the brain abscess with at least 1 year of prior enrollment were included. Statistical analysis was performed from May to December 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>A priori selected study ASMs were levetiracetam, valproate, and phenytoin. A clone-censor-weight approach was used to compare the initiation of ASMs within a 45-day grace period (treatment arm) with no initiation of ASMs (control arm). Inverse probability weights were used to control for treatment selection.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Study outcome was a diagnosis of epilepsy or seizure (with ICD-10-CM<\/jats:italic> code) occurring 15 days or more after the index date. Weighted Kaplan-Meier models were fitted to estimate risk differences (RDs) at 90, 135, and 180 days accompanied by nonparametric bootstrapped 95% CIs. Sensitivity analyses were conducted to assess internal threats to validity.<\/jats:p><\/jats:sec>Results<\/jats:title>Among the 572 patients included, the mean (SD) age was 61.5 (16.6) years and 353 (61.7%) were male. Of those in the treatment arm, 83 (88.3%) initiated ASMs within the first 30 days. Overall, 129 patients (22.5%) developed epilepsy during follow-up. There was no statistically significant risk difference in the probability of epilepsy incidence at each follow-up time point (RD at 90 days, \u20130.02% [95% CI, \u22124.9% to 4.8%]; RD at 135 days, 1.9% [95% CI, \u22125.0% to 8.5%]; RD at 180 days, 3.5% [95% CI, \u20134.4% to 10.8%]). Sensitivity analyses agreed with the primary findings.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of brain abscess survivors, initiation of ASMs was not associated with a reduced risk of epilepsy. Future studies should replicate the findings and consider alternative treatment protocols.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.24557","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T15:30:40Z","timestamp":1754062240000},"page":"e2524557","source":"Crossref","is-referenced-by-count":1,"title":["Initiation of Antiseizure Medications in Patients With Brain Abscess"],"prefix":"10.1001","volume":"8","author":[{"given":"Victoria M.","family":"Nielsen","sequence":"first","affiliation":[{"name":"Department of Public Health and Health Sciences, Northeastern University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Klompas","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts"},{"name":"Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Manjourides","sequence":"additional","affiliation":[{"name":"Department of Public Health and Health Sciences, Northeastern University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa H.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Public Health and Health Sciences, Northeastern University, Boston, Massachusetts"},{"name":"Roux Institute at Northeastern University, Portland, Maine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"issue":"9","key":"zoi250700r2","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1212\/WNL.0000000000000172","article-title":"Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis.","volume":"82","author":"Brouwer","year":"2014","journal-title":"Neurology"},{"issue":"5","key":"zoi250700r3","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1056\/NEJMra1301635","article-title":"Brain abscess.","volume":"371","author":"Brouwer","year":"2014","journal-title":"N Engl J Med"},{"issue":"1","key":"zoi250700r4","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.cmi.2023.08.016","article-title":"European Society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults.","volume":"30","author":"Bodilsen","year":"2024","journal-title":"Clin Microbiol Infect"},{"issue":"11","key":"zoi250700r5","doi-asserted-by":"publisher","first-page":"2825","DOI":"10.1093\/cid\/ciz1153","article-title":"Long-term mortality and epilepsy in patients after brain abscess: a nationwide population-based matched cohort study.","volume":"71","author":"Bodilsen","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"1","key":"zoi250700r6","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/S0967-5868(97)90006-0","article-title":"Epilepsy and brain abscess.","volume":"4","author":"Kilpatrick","year":"1997","journal-title":"J Clin Neurosci"},{"issue":"24","key":"zoi250700r7","doi-asserted-by":"publisher","first-page":"e3213","DOI":"10.1212\/WNL.0000000000010954","article-title":"Epilepsy after brain infection in adults: a register-based population-wide study.","volume":"95","author":"Zelano","year":"2020","journal-title":"Neurology"},{"issue":"2","key":"zoi250700r8","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1007\/s00401-015-1481-5","article-title":"Infections, inflammation and epilepsy.","volume":"131","author":"Vezzani","year":"2016","journal-title":"Acta Neuropathol"},{"key":"zoi250700r9","doi-asserted-by":"publisher","first-page":"S2","DOI":"10.1097\/NRL.0b013e31815bb11b","article-title":"Diagnostic problems in the initial assessment of epilepsy.","volume":"13","author":"Falip","year":"2007","journal-title":"Neurologist"},{"issue":"15","key":"zoi250700r10","doi-asserted-by":"publisher","first-page":"e1611","DOI":"10.1212\/WNL.0000000000206866","article-title":"Risk factors and prognosis of epilepsy following brain abscess: a nationwide population-based cohort study.","volume":"100","author":"Bodilsen","year":"2023","journal-title":"Neurology"},{"issue":"5","key":"zoi250700r11","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1093\/cid\/ciab163","article-title":"Epilepsy prevention after brain abscess: is it time to rethink the indication?","volume":"73","author":"Ito","year":"2021","journal-title":"Clin Infect Dis"},{"key":"zoi250700r12","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.clineuro.2018.07.024","article-title":"Predictors of unprovoked seizures in surgically treated pyogenic brain abscess: does perioperative adjunctive use of steroids has any protective effect?","volume":"173","author":"Lee","year":"2018","journal-title":"Clin Neurol Neurosurg"},{"issue":"8","key":"zoi250700r13","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1093\/aje\/kwv254","article-title":"Using big data to emulate a target trial when a randomized trial is not available.","volume":"183","author":"Hern\u00e1n","year":"2016","journal-title":"Am J Epidemiol"},{"key":"zoi250700r14","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.jclinepi.2016.04.014","article-title":"Specifying a target trial prevents immortal time bias and other self-inflicted injuries in observational analyses.","volume":"79","author":"Hern\u00e1n","year":"2016","journal-title":"J Clin Epidemiol"},{"issue":"8","key":"zoi250700r18","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1136\/jnnp.2009.195073","article-title":"Predictors and long-term outcome of seizures after bacterial brain abscess.","volume":"81","author":"Chuang","year":"2010","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"4","key":"zoi250700r20","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1093\/cid\/ciz890","article-title":"Risk factors for brain abscess: a nationwide, population-based, nested case-control study.","volume":"71","author":"Bodilsen","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"8","key":"zoi250700r21","doi-asserted-by":"publisher","first-page":"e835","DOI":"10.1212\/WNL.0000000000200769","article-title":"Brain abscess and risk of cancer: a nationwide population-based cohort study.","volume":"99","author":"Bodilsen","year":"2022","journal-title":"Neurology"},{"issue":"5","key":"zoi250700r22","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"issue":"11","key":"zoi250700r23","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.","volume":"43","author":"Quan","year":"2005","journal-title":"Med Care"},{"issue":"6","key":"zoi250700r24","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1093\/aje\/kwq433","article-title":"Updating and validating the Charlson Comorbidity Index and score for risk adjustment in hospital discharge abstracts using data from 6 countries.","volume":"173","author":"Quan","year":"2011","journal-title":"Am J Epidemiol"},{"issue":"1","key":"zoi250700r25","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1111\/j.1528-1167.2009.02201.x","article-title":"How accurate is ICD coding for epilepsy?","volume":"51","author":"Jett\u00e9","year":"2010","journal-title":"Epilepsia"},{"issue":"S1","key":"zoi250700r26","doi-asserted-by":"publisher","first-page":"i13","DOI":"10.1136\/injuryprev-2019-043517","article-title":"Multisite medical record review of emergency department visits for unspecified injury of head following the ICD-10-CM coding transition.","volume":"27","author":"Peterson","year":"2021","journal-title":"Inj Prev"},{"issue":"4","key":"zoi250700r27","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1080\/20476965.2019.1581433","article-title":"Key considerations when using health insurance claims data in advanced data analyses: an experience report.","volume":"9","author":"Konrad","year":"2019","journal-title":"Health Syst (Basingstoke)"},{"issue":"5","key":"zoi250700r28","doi-asserted-by":"publisher","first-page":"1719","DOI":"10.1093\/ije\/dyaa057","article-title":"Reflection on modern methods: trial emulation in the presence of immortal-time bias\u2014assessing the benefit of major surgery for elderly lung cancer patients using observational data.","volume":"49","author":"Maringe","year":"2020","journal-title":"Int J Epidemiol"},{"key":"zoi250700r29","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1016\/j.wneu.2018.11.076","article-title":"The effectiveness of antiepileptic medications as prophylaxis of early seizure in patients with traumatic brain injury compared with placebo or no treatment: a systematic review and meta-analysis.","volume":"122","author":"Wat","year":"2019","journal-title":"World Neurosurg"},{"issue":"5","key":"zoi250700r30","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1136\/jnnp-2018-319609","article-title":"Antiepileptic drugs as prophylaxis for de novo brain tumour-related epilepsy after craniotomy: a systematic review and meta-analysis of harm and benefits.","volume":"90","author":"Mirian","year":"2019","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"2","key":"zoi250700r31","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004424.pub2","article-title":"Antiepileptic drugs for preventing seizures in people with brain tumors.","volume":"2008","author":"Tremont-Lukats","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"zoi250700r32","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1161\/STROKEAHA.122.039946","article-title":"Comparative effectiveness and safety of seizure prophylaxis among adults after acute ischemic stroke.","volume":"54","author":"Moura","year":"2023","journal-title":"Stroke"},{"issue":"3","key":"zoi250700r33","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1093\/jamia\/ocad247","article-title":"OHDSI standardized vocabularies-a large-scale centralized reference ontology for international data harmonization.","volume":"31","author":"Reich","year":"2024","journal-title":"J Am Med Inform Assoc"},{"issue":"6","key":"zoi250700r34","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1002\/pds.3197","article-title":"Electronic healthcare databases for active drug safety surveillance: is there enough leverage?","volume":"21","author":"Coloma","year":"2012","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"zoi250700r35","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1186\/1471-2334-12-332","article-title":"Pyogenic brain abscess: a 15 year survey.","volume":"12","author":"Helweg-Larsen","year":"2012","journal-title":"BMC Infect Dis"},{"key":"zoi250700r1","unstructured":"Hall WA, Mesfin FB. Brain Abscess. StatPearls Publishing; 2024. Accessed July 19, 2024. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441841\/"},{"key":"zoi250700r15","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Accessed January 1, 2025. https:\/\/www.equator-network.org\/reporting-guidelines\/strobe\/"},{"key":"zoi250700r16","unstructured":"Observational Health Data Sciences and Informatics. Accessed July 19, 2024. https:\/\/www.ohdsi.org\/"},{"key":"zoi250700r17","unstructured":"IQVIA PharMetrics Plus. Accessed July 19, 2024. https:\/\/www.iqvia.com\/locations\/united-states\/library\/fact-sheets\/iqvia-pharmetrics-plus"},{"key":"zoi250700r19","unstructured":"Athena. Accessed July 19, 2024. https:\/\/athena.ohdsi.org\/search-terms\/start"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2837130\/nielsen_2025_oi_250700_1753385522.82225.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T15:30:41Z","timestamp":1754062241000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2837130"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,1]]},"references-count":35,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.24557","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,1]]}}}