Abstracts

Rationale: There hasn't been good studies for how to wean antiepileptic medications in the epilepsy monitory unit. This study retrospectively compares various ways of weaning medications in the EMU unit and the outcome in terms of seizure number, safety and length of stay. Methods: 106 patient were included in the study at Dartmouth Hitchcock Medical Center. The patients were obtained from EMU registry at Dartmouth and they were obtained from 2016 and 2015 and mostly the patients who stayed 5 days or more in the EMU unit. The variables were age, Type of epilepsy (Temporal, extra-temporal or generalized), weaning method (Cutting doses, stopping one by one and abrupt cessation), type of medications. The outcomes that were evaluated were number of seizures, time to first seizure and ever required rescue medications. Results: Patients remaining on medicines were significantly associated with higher frequency of seizures per month, compared to other groups (P=0.00036). Patients remaining on medicines were somewhat associated with less years of seizures, compared to other groups (P=0.09). Time to first Seizure during admission was not associated significantly with Age, Gender, Years of prior seizures and Reported frequency of prior seizures.Patients with meds stopped one-by-one had significantly shorter time to first seizure, compared to those weaned by other methods even adjusted for years of seizures and reported frequency of seizures on admission (hazard ratio HR 1.73 95%CI 1.09-2.75, P=0.02). Patients remaining on meds still had significantly shorter time to seizure, compared to those weaned by other methods, even adjusted for years of seizures and reported frequency of seizures on admission (hazard ratio HR 2.98 95%CI 1.22-7.24, P=0.016).Patients with abrupt cessation still had longer time to first seizure compared to those weaned by other methods even adjusted for years of seizures and reported frequency of seizures on admission (hazard ratio HR 0.36 95%CI 0.20-0.65, P=0.0007). The difference in time to first seizure was not statistically different for the comparison of weaning by stopping one-by-one vs. by cutting doses (P=0.43).Years of seizures and frequency of seizures on admission were not associated with rescue meds.Weaning technique was not statistically associated with needing rescue meds, although the few patients remaining on medications showed a trend to higher risk (OR 5.0 95%CI 0.77-43 , P=0.20). However, the need for rescue medications was correlated to the number of medications on admission, the more medications, the higher risk for rescue medications especially in temporal lobe epilepsy patients.In temporal lobe epilepsy patients, stopping one by one method was superior to cutting doses in terms of time to first seizure adjusted for years of seizures and reported frequency of seizures on admission. Conclusions: Deciding the best method to wean medications for patients in the epilepsy monitory unit still depends heavily on the clinical judgment of the clinician, However, stopping medications one by one seems to have a little superiority over cutting doses in terms of time to first seizure especially in temporal lobe epilepsy patient.