Seizure Yield vs Risk of Convulsion - A Risk - Benefit Analysis of Anti-seizure Medication Reduction in EMU
Abstract number :
3.207
Submission category :
4. Clinical Epilepsy / 4B. Clinical Diagnosis
Year :
2022
Submission ID :
2204678
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Fred Lado, MD, PhD – North Shore University Hospital; Usman Mirza, MD – Neurology, Northwell Health; John Fitzgerald, MD – Northwell Health; Vikas Shetty, MD – Northwell Health; Simona Proteasa, MD – Northwell Health
Rationale: Inpatient admission to record and characterize seizures with video-EEG is a core function of an Epilepsy Monitoring Unit (EMU). Reduction of anti-seizure medications (ASMs) during epilepsy monitoring unit (EMU) evaluation is a standard practice to increase likelihood of capturing seizures. Reduction of ASMs also increases risk of tonic clonic convulsions. We undertook to quantify the benefit and risk of ASM reduction in individuals undergoing EMU evaluation.
Methods: Since July 2021, our center has maintained a RedCap database of all EMU admissions, including data on the purpose of the admission, whether ASM reduction was undertaken, and specific outcomes, including whether the target event or seizure was captured and whether an individual experienced an adverse event, such as a convulsion. Individuals admitted elective for the purpose of seizure capture were included in the study. Individuals admitted non-electively, via ED for example, or for other indications, e.g., medication toxicity or adjustment, were not included.
Results: A total of 91 patients admitted electively for seizures capture were included in the analysis. ASMs were reduced in 66/91, but target event capture or non-capture was recorded in 64/66 records and missing in 2/66 records. When ASMs were reduced, 27/64 (42%) individuals experienced a seizure. When ASMs were not reduced, only 2/25 (8%) individuals experienced a seizure. The odds ratio (OR) favoring seizure capture with ASM reduction was 8.4 times. Average number of days to capture target event was 1.7, median was 1 day. On the other hand, ASM reduction was associated with generalized tonic clonic seizure (GTC) in 18/66 (27%) patients compared to 0/25 (0%) patient where ASM reduction was not undertaken. Average number of days to first GTC was 2.0, median was 2 days. Sixteen of eighteen (89%) individuals had 1 GTC, while 3/18 (11%) individuals had 2 GTC.
Conclusions: ASM reduction is an effective means of increasing seizure yield with 8.4 times greater likelihood of seizure capture. Interestingly, most individuals had seizure within the first 2 days of admission following ASM reduction. However, our data makes clear that risk of convulsion is increased, with more than a quarter of patients experiencing GTC on average 2 days after medication reduction.
Funding: None
Clinical Epilepsy