EEG Practices and Discontinuation of Anti-Seizure Medications in Epilepsy Patients in the Eastern Mediterranean Region
Abstract number :
2.108
Submission category :
15. Practice Resources
Year :
2025
Submission ID :
375
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Leen Alkalbani, MD – Children's Hospital of Pittsburgh, UPMC
Ruba Benini, MD – Sidra Medicine
Khaled Zamel, MD, FACNS – Weill Cornell Medicine - Qatar
Amal Abulibdeh, MD – University of Jordan Hospital
Modhi Alkhaldi, MD – Imam Abdulrahman bin Faisal University
Nirmeen Kishk, MD – Cairo University
Sally Shaaban, MD, PhD – Faculty of Medicine, Mansoura University
Osama Muthaffar, MBBS, SBPN, CSCN, ABCN – King Abdulaziz University Hospital
William Welch, MD – Children's Hospital of Pittsburgh, UPMC
Ruba Al-Ramadhani, MD – Children's Hospital of Pittsburgh, UPMC
Rationale: Discontinuing anti-seizure medications (ASMs) remains a challenge as limited data exist on EEG utilization and ASM discontinuation in the Eastern Mediterranean. Our study aimed to explore current clinical practices regarding EEG use and ASM weaning in both pediatric and adult epilepsy patients in the region.
Methods: An anonymous online survey was distributed to adult and pediatric neurologists in the Eastern Mediterranean region. It assessed professional background, ASM weaning criteria, EEG utilization, and decision-making influences. Descriptive analysis was used to identify regional patterns.
Results: Sixty-seven healthcare professionals completed the survey by June 3rd, 2025. Responses included adult neurologists 36 (55%), child neurologists 29 (44%), pediatric epileptologists 13 (20%), adult epileptologists 12 (18%), and other epilepsy-managing specialists 7 (9%). Participants represented diverse practice settings including academic hospitals (58%), public hospitals (40%), and private facilities (20%). Most responses (57%) had over five years of clinical experience. Patient populations managed were equally distributed among pediatric, adolescent, and adult groups.
The majority (82%) considered a minimum of two years of seizure freedom necessary before ASM discontinuation. There was greater willingness to wean ASMs in self-limited childhood epilepsy syndromes (89%), followed by generalized epilepsy (68%) and post-surgical cases (60%), while focal epilepsy had the lowest weaning rates (37%).
Key influencing factors included epilepsy etiology (92%), duration of seizure freedom (89%), diagnostic test findings (83%)—with MRI (72%), EEG (62%), and genetic testing (49%)—as well as prior failed weaning attempts (74%) and seizure frequency/severity (68%). EEG was routinely obtained before ASM discontinuation by 86% of responses, with outpatient EEG being the most common modality (80%). Access to EEG was widely available, with 82% reporting routine access and 77% obtaining EEG within one month.
EEG findings such as frequent epileptiform discharges with focal slowing (80%) and generalized slowing with epileptiform abnormalities (60%) commonly influenced decisions to delay ASM withdrawal. While 83% adhered to ILAE guidelines, 45% also followed AAN/AES recommendations. Tapering strategies varied, with 40% favoring a slow taper over 3–6 months, 38% using a shorter taper (4 weeks to 3 months), and 12% adopting individualized approaches. Post-weaning EEG monitoring was uncommon; 71% did not routinely perform follow-up EEG in seizure-free patients. If ASMs were not discontinued based on EEG findings, 45% repeated EEG only upon clinical changes.
Conclusions: Clinicians in the Eastern Mediterranean region commonly incorporate EEG into ASM weaning decisions. However, EEG abnormalities alone influenced decisions in only half of the cases. Despite overall consistency with international standards and strong EEG accessibility, variability in tapering approaches and follow-up practices highlights areas for further standardization and resource optimization.
Funding: NA
Practice Resources