Authors :
Presenting Author: Eric Zhou, MD, MPH – Cleveland Clinic
MarieElena Byrnes, DO, MS – Epilepsy Center, Neurological Institute, Cleveland Clinic
Nicolas Thompson, MS – Cleveland Clinic
Vineet Punia, MD – Cleveland Clinic
Rationale: There are no established guidelines for the duration of anti-seizure medication (ASM) treatment after acute symptomatic seizures (ASyS). Most providers prescribe ASMs after hospital discharge for ASyS, but duration of ASM treatment varies considerably.
1 A recent study showed that discontinuation of ASMs before hospital discharge in neonates with ASyS was not associated with differences in functional neurodevelopment or epileptogenesis compared to neonates who were maintained on ASMs beyond discharge.
2 In this study, we sought to determine the effect of early, before hospital discharge, ASM discontinuation on epilepsy development in adult patients after ASyS.
Methods: We performed a single-center, retrospective cohort study of adults with witnessed or suspected ASyS who underwent continuous EEG monitoring from January 1, 2019 to September 30, 2019 and received maintenance ASMs (≥ 48 hours) during hospitalization. The exposure variable was ASM prescription at hospital discharge. Patients were classified as ‘early ASM discontinuation’ if they were not prescribed ASMs at hospital discharge, and the rest of the study cohort was classified as ‘prolonged ASM use’. The primary outcomes were post-discharge seizure or death as obtained via review of the electronic medical record. We utilized propensity score matching to account for systematic differences between the two patient sub-groups. We then fit a cause-specific Cox proportional hazards model on our propensity-matched sample to calculate hazard ratios to estimate the risk of post-discharge seizures. Death was treated as a competing risk. The Cox proportional hazards assumption was met. All analyses were performed using R 4.3.3, and
p ≤ 0.05 was deemed statistically significant.
Results: We included 387 patients in the study cohort, including 80 (20.6%) in the early ASM discontinuation sub-group. During a median follow-up time of 15.4 months (interquartile range 1.8-33.7 months), 69 patients (18%) had a seizure during the post-discharge period, and 112 patients (29%) died without having a seizure. Table 1 details the two sub-groups before and after propensity matching. The propensity-matched sample included 197 patients (76%) in the prolonged ASM use group and 62 (24%) in the early ASM discontinuation group. In our multivariable model on the propensity-matched sample, there was no statistically significant difference between the two groups regarding risk of post-discharge seizure (HR=0.69, 95% CI=0.28–1.69,
p=0.413) or death (HR=1.51, 95% CI=0.80–2.85,
p=0.206).
Conclusions: Early ASM discontinuation after ASyS in adults was not associated with a significant difference in post-discharge seizures or mortality.
References:
1. Punia V, Daruvala S, Dhakar MB, et al. Immediate and long-term management practices of acute symptomatic seizures and epileptiform abnormalities: A cross-sectional international survey. Epilepsia. 2024;65(4):909-919. doi:10.1111/epi.17915
2. Glass HC, Soul JS, Chang T, et al. Safety of Early Discontinuation of Antiseizure Medication After Acute Symptomatic Neonatal Seizures [published correction appears in JAMA Neurol. 2021 Jul 1;78(7):882]. JAMA Neurol. 2021;78(7):817-825. doi:10.1001/jamaneurol.2021.1437
Funding: N/A