Frequency and Predictors of Antiseizure Medication Discontinuation in Patients with Epilepsy: A Multicenter Retrospective Chart Review
Abstract number :
3.298
Submission category :
7. Anti-seizure Medications / 7C. Cohort Studies
Year :
2022
Submission ID :
2204566
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Adriana Koek, MD – University of Michigan; Geertruida Slinger, MD – Utrecht University; Jeremy Skvarce, BS – University of Michigan Medical School; Mellanie Springer, MD, MS – University of Michigan; Kerri Neville, MD – University of Michigan; Julie Ziobro, MD, PhD – University of Michigan; James Burke, MD, MS – Ohio State University; Willem Otte, PhD – Utrecht University; Roland Thijs, MD – Stichting Epilepsie Instellingen Nederland; Kees Braun, MD, PhD – Utrecht University; Samuel Terman, MD, MS – University of Michigan
Rationale: Guidelines have suggested considering antiseizure medication (ASM) discontinuation in seizure-free patients with epilepsy. Little work has captured how discontinuation decisions are being made in practice. We aimed to determine the frequency and predictors of discussions surrounding ASM discontinuation and decisions to discontinue ASMs.
Methods: We performed a multicenter retrospective cohort study (University of Michigan, UM; Wilhelmina Children’s Hospital, WCH; Stichting Epilepsie Instellingen Nederland, SEIN). We included adults and children with at least one outpatient visit for epilepsy based on ICD-9 codes in January 2015, who had any visit during two years of follow-up where they were seizure-free at least one year. We recorded whether charts documented a discussion or attempt at ASM discontinuation. We conducted multilevel logistic regressions to determine predictors of discontinuation discussions and attempts.
Results: We included 1,056 visits from 463 patients (SEIN: 342; UM: 89; WCH: 32). Of all patients with any visit seizure-free at least one year, 218/463 (47%) had documentation of any discussion surrounding possible ASM discontinuation and 70/463 (15%) had documentation in the note of deciding to attempt ASM discontinuation. Corresponding frequencies for patients seizure-free at least two years were 166/284 (58%) and 54/284 (19%). Figure 1 displays the probability of discussing the possibility of discontinuation and deciding to discontinue ASMs according to clinical variables. For example, the probability of discussing discontinuation and actually attempting to discontinue increased with duration of seizure-freedom, but still even after ten years of seizure-freedom in only 50% of visits did providers discuss the possibility of discontinuation and in only 19% of visits was it decided to discontinue ASMs. Increasing age did not predict chance of reporting ASM discussions but did predict a decreasing chance of discontinuation attempts. The lowest-risk patients according to the current post-discontinuation risk calculator (1,2) had up to a 54% probability of discussing and 24% probability of attempting discontinuation.
Conclusions: Only approximately half of patients with prolonged seizure-freedom or low risk had a documented discussion about ASM discontinuation, and maximally 24% decided to discontinue ASMs in the lowest-risk groups. Future research is needed to understand barriers and facilitators to discontinuation and identify optimal risk thresholds to consider ASM discontinuation.
Funding: Dr. Terman: Susan Spencer Clinical Research Training Scholarship
Anti-seizure Medications