Abstracts

Rationale: Epilepsy is a common neurological disorder affecting children worldwide. It remains challenging for clinicians to determine the optimal timing to discontinue anti-seizure medication (ASM) in seizure-free pediatric patients, as it requires a balance between seizure control, etiology of epilepsy and the adverse effects of prolonged ASM use.1 Electroencephalogram (EEG) findings often play a crucial role in guiding treatment decisions.

Methods: An anonymous survey was distributed among adult and pediatric neurologists, epileptologists, and advance practice providers across the United States through American Epilepsy Society, American Clinical Neurophysiology Society, and Child Neurology Society websites to investigate the utility of EEG in the decision to wean ASM in pediatric patients with seizures. The survey collected data on respondents' level of training, criteria for ASM weaning, influencing factors, and the role of EEG

Results: As of June 4th, 2024, 120 responses were received: pediatric epileptologists 68 (56%), child neurologists 36 (30%), Advanced Practice Providers 14 (11%), and adult epileptologists 2 (2%). Most responders 84% consider two years of seizure freedom before ASM withdrawal, while 2% consider one year. Factors influencing decisions include seizure etiology 98%, patient/caregiver preferences 86%, seizure frequency 79%, medication side effects 70%, and patient aged 65%.
Of Epilepsy types, 93% and 90% of responders favor weaning in generalized epilepsy and self-limited epilepsy syndromes, respectively, while 87% consider weaning in focal epilepsy and 75% mixed epilepsy. EEG practices show 84% providers routinely conduct EEG evaluations before ASM weaning, with routine EEG being most used 59%, inpatient video EEG 17%, and ambulatory EEG 9%. Abnormal EEG findings influenced 48% to refrain from weaning ASM, Although 46% of respondents chose 'Other' when asked whether they would wean ASM based on abnormal EEG results, the majority highlighted that their decision would be influenced by other added factors including, discussions with families, the type of EEG abnormalities, and the specific electroclinical syndrome or epilepsy involved.
If ASM were not weaned due to EEG findings, 70% would schedule a repeat EEG in one year, while (9%) would wait two years. Most providers 67% would not perform an EEG after weaning if the patient remains seizure-free.




Conclusions: Most respondents indicated that they routinely use EEG before considering the weaning of ASMs. However, abnormal EEG alone only influence the decision-making process in about half of the respondents. Although the AAN recommendation guidelines for pediatric populations suggest that EEG abnormalities, particularly epileptiform discharges, can increase the risk of epilepsy relapse1, 48% of respondents suggest that additional factors may guide their decision in clinical practice. These factors include family preferences, type of epilepsy, and epileptiform discharges. This highlights the necessity for standardized EEG practices tailored specifically for pediatric epilepsy patients




1. AAN Guideline Subcommittee. (n.d.). Antiseizure medication withdrawal in seizure-free patients: Practice advisory update summary



Funding: NA