Abstracts

Rationale: Traditionally, antiepileptic drugs are tapered or discontinued in the epilepsy monitoring unit (EMU).  Around 20-50% of patients with epilepsy have psychiatric comorbidities and generally home psychotropic drugs (PD) are continued in these patients. There is sparse data on how psychotropic drugs impact seizure frequency in EMU patients.   Methods: This study included all patients admitted to the University of Louisville EMU for more than 1 day for the evaluation of seizures between 2014 to 2016.  A poisson regression analysis was used to compare seizure frequency for patients on selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants (TCA), serotonin norepinephrine reuptake inhibitors (SNRI), and/or antipsychotics (AP) to those not on these drugs in the EMU. Statistical significance was set by convention at p<0.05.  All data were analyzed using SPSS version 25. Results: 682 patients were analyzed. Patients not on SSRI drugs (n=504) were 1.6 times more likely to have seizures than those on SSRI drugs (n=178) (Incidence Risk Ratio=1.64 [95% CI: 1.21, 2.24], p=0.002). Similarly, patients not on antipsychotic drugs (n=637) were 2.4 times more likely to have seizures than those on antipsychotic drugs (n=45) (IRR=2.41 [95% CI: 1.23, 4.73], p=0.011). No patients on TCA drugs (n=35) had seizures.  Conversely, patients on SNRI drugs (n=43) were 1.9 times more likely to experience seizures than those not on SNRI drugs (n=639) (IRR=1.85 [95% CI: 1.19, 2.86], p=0.006). Conclusions: In our study, people who are taking SSRIs, TCAs, or antipsychotics are less likely to have seizures in the EMU.  Conversely, patients on SNRIs are more likely to have seizures in the EMU.  With the exception of SNRIs, patients who are on PD have less seizures in the EMU compared to patients who are not on PD. Although the mechanism is unknown, this could have implications on the length of stay and may potentially affect decisions regarding medication management in the EMU. Funding: None