# Optimizing anti-epileptic drug treatment in acute brain injury

> **NIH NIH K23** · MASSACHUSETTS GENERAL HOSPITAL · 2021 · $200,880

## Abstract

Project Summary/Abstract
Dr. Zafar is a neurointensivist and clinical neurophysiologist at the Massachusetts General Hospital, whose
goal is to become an independent investigator with expertise in comparative effectiveness research and
pragmatic clinical trials using neurophysiologic tools, to improve outcomes in patients with acute brain injuries
and seizures. Epileptiform abnormalities (seizures and seizure-like rhythmic patterns) are seen on
electroencephalography (EEG) in up to 40% of acute brain injury patients and are associated with worse
outcomes. Due to lack of evidence-based guidance, patients with epileptiform abnormalities are often
aggressively treated with anti-epileptic drugs (AEDs), exposing them to AED related adverse effects that may
worsen outcomes. Dr. Zafar's preliminary data shows that increasing burden of epileptiform abnormalities in
patients with hemorrhagic stroke is associated with worse outcomes. Up to half these patients receive AED
treatment with no improvement in outcomes, and AED use itself is independently associated with worse
outcomes. Dr. Zafar has built a comprehensive EEG database of 2000 patients to investigate AED
effectiveness. In her career development plan, she will be using the rich neurophysiologic data in the EEG
database, along with a nationwide dataset (Premier Healthcare Database) to study AED and EEG utilization
patterns and AED effectiveness in a “real-clinical world” setting. Under the mentorship of Dr. M. Bradon
Westover, and co-mentors (Dr. John Hsu, Dr. Elisabetta Patorno, and Dr. Hang Lee), Dr. Zafar proposes to: 1)
Determine which specific epileptiform abnormalities show an acute response to AEDs by assessing
neurological improvement within 24 hours of treatment (EEG database), 2) Assess the impact of AEDs on in-
hospital clinical adverse outcomes and discharge functional outcomes in acute brain injury patients with
epileptiform abnormalities (EEG database), 3) Investigate how AED-related adverse outcomes vary with
practice patterns across hospitals with different resources and EEG utilization patterns (Premier Database). Dr.
Zafar will perform a systematic exploration of the EEG database to determine EEG phenotypes associated with
response to AED treatment, and determine the impact of AEDs on in-hospital adverse outcomes (e.g.
mortality, hepatotoxicity, cardiac events). To account for national variation in AED prescription, hospital
resources and EEG use, Dr. Zafar will examine adverse outcomes in the Premier Database. In addition to the
proposed research, Dr. Zafar's career development plan includes a Masters of Science and coursework on
analysis of large databases, pharmacoepidemiology and machine learning. Dr. Zafar will receive guidance
from her mentors and advisors with diverse clinical and scientific expertise. The proposed training will allow Dr.
Zafar to establish a niche in using neurophysiologic data in comparative effectiveness research and launch an
independent research career ...

## Key facts

- **NIH application ID:** 10223451
- **Project number:** 5K23NS114201-03
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Sahar F Zafar
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $200,880
- **Award type:** 5
- **Project period:** 2019-09-30 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10223451

## Citation

> US National Institutes of Health, RePORTER application 10223451, Optimizing anti-epileptic drug treatment in acute brain injury (5K23NS114201-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10223451. Licensed CC0.

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