Trade Offs of Anti-Seizure Medications in Patients with Well Controlled Epilepsy
Abstract number :
2.264
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2025
Submission ID :
711
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Genevieve Rudy, – University of Michigan
Amy Kim, N/A – University of Michigan
James Burke, MD MS – Ohio State University
Palak Patel, MD – Hackensack Meridian School of Medicine
Chloe Hill, MD MS – University of Michigan
Radiah Khandokar, BS – SUNY Dowfnstate
Susanna O'Kula, MD – State University of New York Downstate Health Sciences University
David Hutton, PhD MS – University of Michigan
Samuel Terman, MD MS – University of Michigan
Rationale: Patient preferences are critical to delivering values-concordant care, particularly when clinical equipoise exists between treatment options. Particularly in epilepsy care, deciding whether who should remain on antiseizure medications long-term after a period of seizure remission involves complex pros and cons. However, little is known regarding what side effects/outcomes matter the most to patients when making medical decisions. We sought to quantify patients’ levels of concern when presented with various hypothetical seizure risks compared to downsides of antiseizure medications.
Methods: We conducted a prospective survey of patients with epilepsy who were 18+ years of age, 1+ year seizure free. We administered a best worst scaling survey in which we asked patients to choose the most and least concerning item if they were hypothetically true from smaller subsets from a larger list. There were 13 items, which included different seizure risks (e.g. 1%, 5%, 20%, 50%), side effects (e.g. cognitive, sleepiness, mood), and time frames to drive (e.g. 3 months, 6 months, 1 year). We analyzed responses using a best worst scaling (BWS) score, calculated by the number of times each item was chosen as the most concerning minus how many times each item was chosen as the least concerning.
Results: Of the 352 patients screened to date, 117 (33%) were eligible, and 37 (32% of those eligible) surveys were completed. The median age was 38 years (interquartile range [IQR] 27-64), 18 (49%) were female, and the median seizure free duration was 2.7 years (IQR 1.5-11.3). The options chosen as the most concerning were a 50% seizure risk in the next year and difficulty thinking, with median BWS scores of 3 (IQR 2-4) and 2 (IQR 1-3), respectively (Figure 1). The least concerning hypotheticals were the burden of medication twice daily, a cost of $10/month, and 1% seizure risk in the next year with respective median best worst scaling scores of -3 (IQR -3--1), -2 (IQR -3--1), and -2 (IQR -2-0). Items with the highest probability of being chosen as the most concerning in each question block were: 50% seizure risk in the next year (71%, confidence interval [CI] 95% 64%-78%) and difficulty thinking (55%, CI 95% 47%-63%) (Figure 2). Items with the lowest probabilities for being chosen as the most concerning were: $10/month medication cost (< 1%, CI 95% < 1% to < 1%) and taking medication (10%, CI 95% 5%-15%).
Clinical Epilepsy