An International Survey of Acute and Chronic Management Practices of Acute Symptomatic Seizures and Highly Epileptiform Abnormalities on EEG
Abstract number :
2.134
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2022
Submission ID :
2205042
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Sanaya Daruvala, MD – Warren Alpert School of Medicine, Providence, RI; Vineet Punia, MD, MS – Charles Shor Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH; Adithya Sivaraju, MD – Neurology – Yale University, New Haven, CT; Sahar Zafar, MD – Neurology – Massachusetts General Hospital; Clio Rubinos, MD, MS – Neurology – University of North Carolina; Lawrence Hirsch, MD – Neurology – Yale University, New Haven, CT; Monica Dhakar, MD, MS – Neurology – Warren Alpert School of Medicine of Brown University
Rationale: Acute symptomatic seizures (ASyS) are seen in 15% to 40% of critically ill patients. Moreover, the increased availability and use of continuous electroencephalography (cEEG) in this patient population has led to identification of various periodic and rhythmic patterns, often falling on the ictal-interictal continuum (IIC). However, there are no uniform guidelines for the optimal duration of treatment with anti-seizure medications (ASMs) in patients with ASyS and IIC patterns. Hence, the objective of this study was to conduct an international survey to evaluate practice patterns in the management of ASyS and IIC in critically ill patients.
Methods: We disseminated a web-based, anonymous survey to providers caring for patients with ASyS through various national societies and social media platforms during a 3-month period. The survey consisted of 26 questions and was designed as a series of theoretical, fixed-response questions based on a commonly-encountered clinical scenario. Participants were requested to select the response option that best matched their current management practices. Approaches to ASM selection, escalation, and duration were assessed along with recommendations on ancillary testing and outpatient follow-up.
Results: Of 481 participants from 42 countries who completed the survey, the majority were epileptologists (51.8%) at academic centers (62.8%) with an average of 3.6 years in clinical practice. More than 80.0% of participants were likely to treat ASyS with ASM in the hospital irrespective of etiology of acute brain injury. In patients without clinical seizures but with IIC pattern on EEG, 66.9% of participants chose to treat with ASM. Once an ASM was started in the hospital, the majority (84.8%) of participants chose to discharge patients on ASM until outpatient follow-up. There was wide variability in practices of long-term continuation of ASMs and further investigations. The recommended duration of treatment with ASM was variable with 36.3% of participants indicating 3 to 6 months and 28.7% suggesting 1 to 3 months. Half of the participants (50.5%) recommend 6 months of driving restrictions after acute symptomatic seizures.
Conclusions: Our survey demonstrates a general consensus for treating ASyS with ASMs. However, it reveals wide variability in practice patterns in the management of IIC patterns, duration of ASyS treatment, and long-term ASM continuation. This clinical equipoise deserves further investigation through comparative effectiveness studies and clinical trials.
Funding: Research funding was from the American Epilepsy Society Infrastructure grant.
Clinical Epilepsy