Authors :
Presenting Author: Lara Wadi, MD – Duke University Hospital
Hussein Al-Khalidi, PhD – Duke University Hospital; Prachi Parikh, MD – Duke University Hospital; Shakthi Unnithan, MS – Duke University Hospital
Rationale:
There is little information guiding decision-making regarding long term anti-seizure medication (ASM) management following first time hospitalization for status epilepticus. The objectives of this study are to identify clinical and electro-diagnostic factors that influence the decision to wean ASMs in the outpatient setting, to compare seizure recurrence rates between ASM continuation and ASM withdrawal groups, and to study the effect of the taper duration (slow >2 years versus rapid ≤2 years) on seizure recurrence.
Methods:
This was a single center retrospective observational study based on chart review over a 10-year period (1/1/2011-1/1/2021) using the Duke University Health System (DUHS) electronic medical record. The study included adults (≥ 18 years of age) who presented to the emergency department or were hospitalized at Duke University Hospital for status epilepticus and who were seen in follow-up in the outpatient setting.
Results:
Two hundred eighty-four cases (mean age 55, 52.8% male) were identified and included in the study. 51.4% had a prior history of seizures, and 39.5% underwent ASM taper following index hospitalization. A logistic regression model was used to assess the association between ASM taper within a one to two year follow-up. The following clinical factors were found to be associated with a higher likelihood of undergoing ASM taper: type of status (focal vs. generalized with OR 2.02 [1.18, 3.46], p-value 0.0108) and provoked status (provoked vs. unprovoked with OR 1.89 [1.08, 3.31], p-value 0.0259). There were no statistically significant associations between ASM taper at one to two year follow-up and prior history of seizure (prior seizure vs. no prior seizure with OR 0.57 [0.28, 1.13], p-value 0.1055), number of ASMs before SE hospitalization (OR 1.41 [0.91, 2.2], p-value 0.1235), type of IV anesthetic used (midazolam vs. propofol with OR 0.6 [0.22, 1.65], p-value 0.3255), comorbidities, or completion of outpatient EEG (35.7% of patients with ASM taper had outpatient EEG compared with 27.3% of patients without ASM taper, p-value 0.1349). 79.2% of patients with ASM taper did not have seizure recurrence within six months of taper. Pearson’s chi-square test was used to compare seizure recurrence rates between slow and rapid ASM taper and found no statistically significant difference between the duration of taper and seizure recurrence within six months (114 patients with rapid taper, of which 20 [21.3%] had seizure recurrence at six months, compared with four with slow taper, of which zero (0%) had seizure recurrence, p-value 0.5788).Conclusions:
These findings suggest that clinical factors such as focal SE and provoked SE are associated with a higher likelihood of weaning ASMs in the outpatient setting. Most patients did not have seizure recurrence within 6 months of ASM taper, and the duration of taper, ≤2 years compared with >2 years, did not significantly affect recurrence rates. Prospective studies are indicated to validate these results to further guide the outpatient management of ASMs following index hospitalization for status epilepticus.Funding: none