Abstracts

Rationale: There is wide variation in epilepsy monitoring unit (EMU) protocols for anti-seizure medication (ASM) withdrawal due to differing opinions on its level of safety in seizure localization. There is a paucity of safety data available for immediate withdrawal of anti-seizure medications. Given the expense and inconvenience of lengthy EMU stays, reporting of safety data is warranted






Methods:



407 patient charts were reviewed over a span of 2023-2018 at the University of South Alabama Epilepsy Monitoring Unit in Mobile, Alabama, USA. Patients who were on at least one ASM which was immediately and fully withheld upon admission were included (partial or gradual ASM withdrawal is not performed in this EMU). Patients who were admitted for intracranial monitoring were excluded.






Results: The mean time to first seizure was 21.3 hours. A typical seizure was captured in 59.5% of patients with suspected or proven epilepsy. The average number of ASM’s was 2. The rate of complications was 29.0% [including seizure cluster (20.3%), new onset secondary generalization (5.8%) and tongue biting (5.8% each)]. No falls, pneumonia, respiratory or cardiac events, Todd’s paresis, ICU transfer, postictal psychosis, significant trauma, or generalized status epilepticus occurred in any patients. The percentage of patients with epilepsy with status epilepticus (seizure longer than 5 minutes) was 1.45% (3 patients, each were focal seizures), each were on at least 3 ASM’s prior to admission and had no further complications after rescue medications were given and ASM’s were restarted. Only one patient had a brief secondary generalization but none had convulsive status epilepticus. These patients were on 4, 3, and 4 home AMS’s prior to admission respectively. The average home seizure frequency of the patients with prolonged seizures was 6.7 episodes per month as compared to 38.7 for those with seizure clusters and 20.3 for all those with epilepsy.




Of the 3 patients who had a seizure longer than 5 minutes, the patient with the longest clinical focal seizure was 36 minutes which resolved with 4 successive doses of 2 mg of lorazepam and the patient returned to baseline without any other complications. This patient had a history of prior status epilepticus. This patient had no further seizures after starting home antiseizure medications. The 2nd patient had 18 minutes of clinical and electrographic focal seizure which resolved spontaneously without rescue medication and had no further seizures. This patient had no history of prior status epilepticus. The 3rd patient had 14 minutes of clinical focal seizure with late secondary generalization which resolved with lorazepam 2 mg IV. They had no further seizures. There were no other complications in any of these patients besides prolonged seizures. Only one patient had a brief secondary generalization. These patients were on 4, 3, and 4 home AMS’s prior to admission respectively. The average home seizure frequency these patients was 6.7 episodes per month as compared to 38.7 for those with seizure clusters and 20.3 for all those with epilepsy.">










Conclusions: Immediate full withdrawal of anti-seizure medications in select patients who do not have frequent seizures despite multiple antiseizure medications at home is a safe and effective method of diagnosing epilepsy in adults greater than 18 years old when monitoring properly in an inpatient epilepsy monitoring unit as long as rapid rescue medications are given for prolonged seizures and anti-seizure medication regimens are restarted in a reasonable period of time. None of the patients with prolonged seizures in this study had clinically significant complications.








Funding: No funding was obtained for this study