Abstracts

Rationale: Patients admitted to the epilepsy monitoring unit (EMU) often undergo swift anti-seizure medication (ASM) dose changes aimed at increasing likelihood of event capture, seizure characterization, or surgical planning. While useful and efficient, rapid ASM dose changes risk adverse effects, including the possibility of tonic-clonic seizures and status epilepticus, that are not the goal of admission.
The present investigation aims to characterize the approaches to ASM reduction and reintroduction used by epilepsy specialists within a large hospital system, as a first step in developing a uniform practice for ASM reduction that optimized seizure yield while minimizing risk for patients electively admitted to the EMU.  

Methods: An observational pilot study was carried out via a survey distributed to the epilepsy faculty of the Northwell Health Hospital System across three NAEC Level 4 and one NAEC level 3 epilepsy centers. Questions explored the timing, order and rate of ASM reduction and reintroduction. Replies to single-answer questions were tallied, while those involving ranking or an open response were further analyzed for similarities and disparities underlying patterns of practice.  

Results: Data collection is ongoing at the time of abstract submission. Initial results (N=5) suggest the following: 1-Initiation of ASM reduction was favored to begin at the start of EMU admission.
2-A sequential, one-by-one dose-reduction of ASMs was favored, with an initial 1/3 total dose reduction.
3-ASM half-life was favored to be the highest priority in choosing order of ASM down-titration.
4-The five most important factors in deciding on order of ASM dose-reduction were (in descending order): i. reason for EMU stay, ii. history of generalized tonic-clonic seizures iii. ASM half-life, iv. projected length of EMU stay, v. ASM mechanism of action (MOA).
5-ASM MOA was not an important factor in determining which ASM to dose-reduce first.
6-The three most important factors in deciding on order of ASM dose-reinitiation were (in descending order): i. ASM half-life, ii. ASM MOA, iii. ASM dose relative to regular outpatient dose.



Conclusions: Currently, data continues to be actively collected for this pilot study. Further plans for expanding the sample size include polling epilepsy faculty at hospitals outside of the Northwell system, across disparate geographical regions and population densities. Additionally, faculty at both academic and community hospitals will be polled.

Funding: None