Abstracts

Rationale: There are limited data on weaning of antiepileptic drugs (AED) after admission for status epilepticus (SE). The purpose of this study was to describe clinical practice in that domain and evaluate possible predictors that affect decision making. Methods: Retrospective review of adult patients admitted to Emory University with electrographically proven SE from January 2014 to June 2017 was performed. Patient demographics, SE characteristics, and longitudinal AED management information were collected. Results: Nineteen patients (63% female) were collected so far (ongoing enrollment). Half of them had no prior history of epilepsy. The majority (53%) were admitted with non-convulsive SE and due to acute/subacute insult (63%). At baseline, half of the patients were on no AED and the mean AED burden was 0.63. Upon discharge, all patients were on AED with the mean AED burden at 2.73. In the first follow-up time (~6 months), all patients were still on AED with the mean AED burden at 2.78. From them, 41% had the same, 35% had decreased, and 24% had increased AED burden. The mean AED burden change between discharge and ~6 months follow-up time was a mean increase by 0.35 AED. In the second follow-up time (~12 months), 92% remained on AED. The mean AED burden was 2 AED. Compared to discharge, 59% had partial AED reduction and 33% were on similar regimen. The mean AED burden change between discharge and ~12 months follow-up time was a mean decrease of AED by -0.5 AED. Compared to the first follow-up time (~6 months), 50% of patients underwent at least partial AED taper and 50% were maintained on identical regimen. The mean AED burden change between ~6 and ~12 months of follow up was a reduction by -1.5 AED. Aside for a trend (Fischer’s exact test, p=0.08) of faster AED wean in male patients seen only in the ~12 months follow-up time, there was no statistically significant demographic or disease-related predictor for AED taper. Conclusions: Status epilepticus management requires a substantial increase in AED burden in the acute phase, regardless of patient age, status etiology, and prior history of epilepsy. That AED burden appears steady for the subsequent 6 months and gradually declines in approximately half of the patients 12 months later, with a minority only becoming AED free, even in de novo cases. Further longitudinal studies are required to elucidate the optimal timing, pace, and predictors of AED weaning post SE. Funding: No funding