Abstracts

Rationale: Different strategies are applied to provoke seizures during Epilepsy Monitoring Unit (EMU) admission, of which withdrawal of anti-epileptic drugs (AEDs) is most effective. One challenge for families whose children are undergoing evaluation for epilepsy is the unpredictable length of hospitalization for video-electroencephalograph monitoring. AED withdrawal before admission increases the probability of recording seizures during a pre-defined duration of admission, so helping to reduce the length of stay. Very little is published on withdrawl of AEDs in pediatric patients. Our goal is to provide safe and effective guidelines for AED withdrawal in pediatric patients admitted to EMU.

Methods: A systematic review was conducted to search publications on AEDs in adult and pediatric populations. Information was reviewed by multiple epileptologists and a pediatric pharmacist to develop an evidence based guideline.

Results: AED withdrawal in pediatric patients undergoing evaluation in EMU may not always lend itself to a protocol-driven approach, however, there are certain general principles that can be followed in a stepwise fashion to guide medication withdrawal. Patient characteristics including frequency of seizures and history of status epilepticus must initially be considered to decide if the patient is a candidate for weaning. Medication characteristics including half life and chance of withdrawal seizures need to then be weighed to make the full withdrawal plan.

Conclusions: AED withdrawal at home prior to EMU admission for pediatric patients can be a safe method to increase the diagnostic yield of EMU assessment.

Funding: Please list any funding that was received in support of this abstract.: none.