Safety and Efficacy of Reducing Long-acting vs. Short-acting Anti-seizure Medications in Epilepsy Monitoring Units
Abstract number :
3.437
Submission category :
7. Anti-seizure Medications / 7E. Other
Year :
2024
Submission ID :
264
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Javier Otero, MD – Zucker School of Medicine at Hofstra Northwell
Rationale: To evaluate the safety and efficacy of reducing long-acting (LA) versus short-acting (SA) anti-seizure medications (ASM) during epilepsy monitoring unit (EMU) evaluation in capturing seizure events and assessing the associated risk of tonic-clonic convulsions.
Methods: A retrospective analysis was conducted on 13 patients admitted to the EMU for presurgical evaluation. Patients underwent ASM reduction to increase the likelihood of capturing seizure events. The cohort was divided based on the type of ASM reduced: LA drugs in 4 patients and SA drugs in 9 patients. The long-acting ASMs, defined as those with a half-life of more than 50 hours, included Xcopri, Perampanel, Onfi, and Zonegram. In contrast, the short-acting ASMs included Keppra, Lacosamide, and Oxcarbazepine. The incidence of convulsive seizures, the timing of these seizures, and statistical measures such as confidence intervals and P-value were recorded.
Results: All 13 patients (100%) experienced seizure events during their EMU stay. Convulsive seizures occurred in 3 out of 4 patients (75%, 95% CI: 30.1% to 95.4%, p = 0.25) with reduced LA drugs and in 1 out of 9 patients (11.1%, 95% CI: 2.0% to 43.5%, p = 0.0004) with reduced SA drugs. The average number of days to a convulsive seizure was 2.6 days (SD = 0.58) in the LA group and 5 days in the SA group. ASM reduction was associated with generalized tonic-clonic (GTC) seizures in 4 out of 13 patients (30.8%, 95% CI: 12.7% to 57.6%, p = 0.1336), while 10 out of 13 patients (76.9%, 95% CI: 49.7% to 91.8%, p = 0.0204) experienced seizures without GTC.
Conclusions: ASM reduction in the EMU is effective in capturing seizure events. However, in our study, reducing LA ASMs posed a higher risk of inducing convulsive seizures compared to reducing SA ASMs. The timing of convulsive seizures is shorter in the LA group, indicating a potentially higher immediate risk. These findings suggest a need for careful consideration and monitoring when reducing LA ASMs in EMU settings to balance seizure capture and patient safety.
Funding: None
Anti-seizure Medications