Abstracts

Rationale: AED treatment is often initiated in acute settings when clinical seizures are encountered. Although the treatment is appropriate in most situations, AEDs are sometimes initiated and continued without sound scientific reasoning. Understanding the prevalence and causes of inappropriate AED use in acute practice is needed to protect patients from unnecessary AED exposure and to improve safety and quality of neurological care.


Methods: The study is based on electronic medical records from a community hospital of about 200 beds with an additional 30 bed emergency department. Patients who were initiated and discharged on ≥1 of the 4 most common intravenous AEDs (levetiracetam, lacosamide, phenytoin, and valproate) during their ED visits or hospital admission between 9/10/2022 -10/14-2023 were reviewed. Patients with definitive risk factors for seizures that justify the use of AEDs were excluded. Exclusion criteria included: 1) idiopathic or recurrent clinical seizures of >24 hours apart with epileptic semiology, 2) positive EEG findings to suggest epileptogenicity; 3) confirmed of current or previous cortical lesions of any causes or hereditary epilepsy; 4) AED is recommended by neurologist; 5) AED was discontinued at discharge.


Results: Of the 10 patients who were initiated and discharged on levetiracetam, 9 patients failed to meet criteria for initiating AED therapy. Among them, 3 had alcohol withdrawal-related seizures, 3 had unverified history of seizure-like events, 1 with suspicious semiology without further work-up, 1 was non-neurological, 1 received AED without seizure diagnosis. No patient was initiated on lacosamide, valproate or phenytoin.


Conclusions: Our results from a single site suggest underestimated inappropriate use of AEDs in the acute setting. It justifies the necessity to perform large scale studies to verify the preliminary findings and to determine the potential risks to patients. As of submission of this abstract, we are initiating this investigation in a second center. Our study will help bring to focus the possibility of over prescription of AEDs exposing patients to the risk of potential side effects when the clinical indication for their initiation may not be appropriate. As neurologists and providers this study has the potential to change practice in a more evidence-based manner by critical assessing if AEDs are truly indicated during acute care patient encounters.


Funding: No funding was required for this project at the time of this submission.