Abstracts

Rationale: It is well accepted that certain drugs can lower seizure threshold and in certain situations provoke seizures. We use this to our advantage in patients admitted to the epilepsy monitoring unit. Often patients take many days to have a seizure thus prolonging hospital stay and often necessitating further admissions if seizures are not captured. In our institution we use certain drugs to provoke seizures although there is no real evidence-basis to support this. We wished to survey epileptologists to determine what their practices were with regards to seizure provoking agents. Methods: A brief survey (Fig.1) was sent out to 100 epileptologists to determine if they used agents to provoke seizures in their epilepsy monitoring unit population. If they did we went on further to ask why they did so and if there was any evidence basis for this. We also questioned whether the seizures captured after use of medications were different to the patient’s typical events Results: Of the 100 physicians surveyed we had a 58% response rate. 79%(46 physicians) did not use any seizure provoking agents, 17%(10 physicians) did and 4%(2 physicians) used to use ethanol but no longer did so after an adverse event. Of those physicians that did use seizure provoking agents; ethanol, diphenhydramine and tramadol were the drugs used. One institution (2 physicians) said they used bupropion and tramadol in patients with intracranial electrodes but did not find them to be helpful. 50%(5 physicians) of the physicians that used seizure provoking agents did so because of evidence that the agents lowered seizure threshold. The other 50%(5 physicians) said there was no evidence for their practice but it is what was done at their institution. Of all the physicians who used drugs to provoke seizures none felt the drugs caused a change in the patient’s habitual clinical seizure. Conclusions: From our informal survey we can see that the use of seizure provoking agents is very uncommon amongst epileptologists. A concern raised by many responders was that the use of such agents would change the seizure semiology. Amongst the few physicians that do use drugs to provoke seizures this does not seem to be their clinical experience. There is little data in the literature on this subject save for the fact that drugs like antihistamines, bupropion, tramadol and ethanol do lower seizure threshold (Wills B et al,.2005.Med Clin N Am 89:1297-1321). We acknowledge that the only way to tell if there are truly any differences between provoked and spontaneous clinical seizures is by doing a prospective study looking at the use of seizure provoking agents in patients undergoing phase I evaluation or invasive monitoring for preoperative surgical focus localization.