Prospective Evaluation of Outpatient Management and De-escalation of Antiseizure Medications in Acute Symptomatic Seizures Following Brain Injury
Abstract number :
2.26
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2025
Submission ID :
496
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Thiri Lin, MD, PhD – UNC Health
Arthor Amith-Ayala, BA – UNC Health
Neishay Ayub, MD – Brown University
Vineet Punia, MD – Cleveland Clinic, Cleveland, OH, USA
Adithya Sivaraju, MD – Yale New Haven Hospital
Sahar Zafar, MD, MBBS – Massachusetts General Hospital
Clio Rubinos, MD, MS, FACNS – University of North Carolina, Chapel Hill, North Carolina, USA.
Rationale: There is limited standardization on the management of acute symptomatic seizures (ASyS) after hospital discharge, particularly related to decisions about ASM adjustment and contributing factors guiding clinical practice. To address this gap, we conducted the first prospective longitudinal study evaluating the management of ASyS at defined intervals post-hospitalization. Our primary aims included assessing ASM changes, identifying reasons against medication de-escalation, and evaluating the utilization of outpatient EEG at 3, 6, and 12-month follow-up visits.
Methods: We prospectively evaluated 59 patients from the UNC Post-Acute Symptomatic Seizure (PASS) clinic from 2021–2024. All participants experienced clinical or electrographic ASyS during hospitalization at UNC Health, with etiologies including intracranial hemorrhage, brain tumor, anoxic brain injury, CNS infection, PRES, TBI, autoimmune, and toxic-metabolic encephalopathy. Patients were systematically evaluated at 3, 6, and 12 months post-discharge. Primary outcomes included ASM modifications at each follow-up, factors influencing decisions against medication reduction, and outpatient EEG use. Secondary outcomes encompassed interval clinical seizures, ASM side effects, rehospitalization rates, driving status, and current living arrangements (home, rehab facility, nursing home, skilled nursing).
Results: Among the 59-patient cohort, the rate of interval clinical seizures remained stable across the three time points (3-month: 8.5%; 6-month: 8.4%; 12-month: 11.9%). However, the proportion of patients continuing ASM notably declined with subsequent visits: from 64.4% at 3 months, to 57.5% at 6 months, and 37.3% by 12 months. Outpatient EEG was utilized as adjunctive data in 20.3%, 22.0%, and 11.8% of patients at the 3, 6, and 12-month intervals, respectively. Significantly, at the initial 3-month PASS clinic follow-up, 55.2% of patients underwent ASM modifications. On average, 32% of patients reported ASM-related side effects at each follow-up. Approximately 12.8% of patients or family members consistently expressed a desire for ASM reduction during visits. The most commonly cited reason against ASM de-escalation was concern for elevated seizure risk, identified in 39.5%, 25%, and 22.7% of cases at the respective 3, 6, and 12-month intervals. Additionally, one patient displayed persistent epileptiform activity on outpatient EEG at the 12-month follow-up.
Conclusions: While no significant differences were found in interval clinical seizure frequency across the three post-discharge intervals, we observed a consistent decrease in ASM use over time, suggesting cautious and tailored medication tapering. Patient preference, clinician perception of seizure risk, and timing concerns emerged as key determinants in decisions against medication reduction. Notably, concerns regarding high seizure risk dominated at all three follow-ups. Importantly, more than half of the cohort underwent medication adjustments upon first outpatient evaluation. Future studies should prioritize patient education about epilepsy, seizure recognition, and seizure first aid, aiming to empower patients and promote safe ASM practices following ASyS.
Funding: N/A
Clinical Epilepsy