Abstracts

Rationale: Hospitalized patients with epilepsy may not be able to take their home oral antiepileptic drugs (AEDs) due to NPO ("nil per os," nothing by mouth) status or gastrointestinal disease. Strategies to maintain seizure control in such patients include: intravenous or non-pill oral formulations of the patient's home AED(s), alternative intravenous AED(s), or a benzodiazepine bridge. No published data exist on the frequency with which these strategies are used or to guide the selection of one strategy over another. Methods: Patients with epilepsy admitted to two academic medical centers were identified via a clinical data registry using the search criteria "epilepsy and recurrent seizures," "inpatient," and "paralytic ileus and intestinal obstruction without hernia." Clinical documentation for these patients was reviewed in order to confirm that they had a diagnosis of epilepsy, were taking oral AEDs, and were admitted for an intra-abdominal condition for which NPO status was documented. If more than one relevant admission was found, the most recent admission was used. Medication orders were reviewed and AED selection (medication and route of administration) was recorded. Results: 301 patients were identified by the search criteria; 167 patients had a relevant admission. 88 patients were NPO including oral AEDs. 80 of these patients (90.9%) were treated with AEDs, while 8 patients (9.1%) were not. 50 of the treated patients (62.5%) were taking oral AED monotherapy at baseline; among them, 43 patients (53.8%) were treated with the same AED intravenously, while 7 patients (8.8%) were treated with a different IV AED. 30 of the treated patients were taking oral AED polytherapy at baseline; among them, 4 patients (13.3%) were treated with IV AED monotherapy, 8 patients (26.7%) were treated with IV AED polytherapy using only home medications, and 18 patients (60.0%) were treated with a combination of home and new IV AEDs and benzodiazepines. 79 patients were "NPO except medications" and continued to take their home oral AEDs; 15 of these patients (19.0%) had concurrent nasogastric suction, 3 of whom (3.8%) were taking AEDs that are available intravenously. Conclusions: Most hospitalized epilepsy patients who cannot take their home oral AEDs are treated with AEDs. However, among patients who were completely NPO, nearly one in ten patients was not treated with AEDs, and among patients in whom oral AEDs were continued despite NPO status, one in five patients had concurrent nasogastric suction. These treatment decisions could result in breakthrough seizures, especially when the seizure threshold has been lowered by medical illness or surgical intervention. Further studies are necessary to determine the optimal management strategy for prevention of breakthrough seizures in hospitalized patients who cannot tolerate oral medications. Funding: None