Abstracts

Antiseizure Medication Withdrawal Practice Patterns: A Survey Among Members of the American Academy of Neurology and Epicare

Abstract number : 1.221
Submission category : 4. Clinical Epilepsy / 4C. Clinical Treatments
Year : 2022
Submission ID : 2203960
Source : www.aesnet.org
Presentation date : 12/3/2022 12:00:00 PM
Published date : Nov 22, 2022, 05:22 AM

Authors :
Samuel Terman, MD MS – University of Michigan; Geertruida Slinger, MD – Utrecht University; Carol Rheaume, MSPH – American Academy of Neurology; Anisa Haque, BS – University of Michigan; Shawna Smith, PhD – University of Michigan; Renate van Griethuysen, MSc – SEIN; Charlotte van Asch, PhD – SEIN; Willem Otte, PhD – Utrecht University; James Burke, MD MS – Ohio State University; Kees Braun, MD PhD – Utrecht University

Rationale: To describe neurologist practice patterns, challenges, and decision support needs pertaining to withdrawal of antiseizure medications (ASMs) in patients with well-controlled epilepsy.

Methods: We sent an electronic survey to three groups: (1) U.S. and (2) European physician members of the American Academy of Neurology, and (3) members of EpiCARE, a European Reference Network for rare and complex epilepsies. Statistical analyses included frequencies and percentages and showed distributions through histograms and violin plots.

Results: We sent the survey to 4,923 individuals; 463 consented, 411 passed eligibility questions, and 287 responded to at least one of these questions. Most respondents indicated they might ever consider ASM withdrawal, with respondents treating mostly children being more likely ever to consider withdrawal (p < 0.05). The most important factors when making decisions included seizure probability (83%), consequences of seizures (73%), and driving (74%). The top challenges when making decisions included unclear seizure probability (81%), inadequate guidelines (50%), and difficulty communicating probabilities (45%). Respondents would consider withdrawal after a median of two years seizure-freedom, but also responded they would begin withdrawal on average only when the post-withdrawal seizure relapse risk in the coming two years was less than 15-30%. Wide variation existed in the use of words or numbers in respondents’ counsel methods, for example percentages versus frequencies or probability of seizure-freedom versus seizure. The most highly rated point-of-care methods to inform providers of calculated risk were Kaplan-Meier curves and showing percentages only, rather than pictographs or text recommendations alone.
Clinical Epilepsy