Clinicians’ Views on Antiepileptic Medication Management in Nonepileptic Seizures

Abstract

Discontinuation of antiepileptic drugs should be a first step in treatment of nonepileptic seizures without comorbid epilepsy. However, clinical practices vary and standardized guidelines are not available. The aim of this study was to survey members of the American Epilepsy and Child Neurology Societies about factors that influence their decision about antiepileptic drug management in patients with nonepileptic seizures. A total of 236 respondents completed this survey, of whom 84% were academic pediatric neurologists and 96.2% were very willing to discontinue antiepileptic drugs in these patients. Clinicians with sufficient knowledge about nonepileptic seizures had fewer concerns about the potential for medical errors, were less influenced by requests made by patients or parents to continue antiepileptic drugs, and were comfortable making this decision if patients receive ongoing psychiatric care. Results of this survey highlight the need to examine if the same factors are involved in a large sample of community clinicians.

Ethical dilemmas in pediatric and adolescent psychogenic nonepileptic seizures

“…Neurologists may feel an obligation to shield their patients from these burdens by only considering PNES if other potential causes are ruled out. All of these things may lead to a delayed diagnosis and disrupts a patient’s ability to get care, which comes with a substantial burden to the individual patient and the patient’s family [58]. Young patients are at risk for misdiagnosis and cognitive delays as a result of inappropriate medical treatment, e.g.…”

“…In cases where PNES is confirmed as the only seizure disorder, continued treatment with AEDs is unnecessary and could be associated with adverse cognitive and behavioral effects. In a recent survey of 236 neurologists (84% of whom are pediatric neurologists in academic settings), up to 96% of respondents felt confident about discontinuation of AEDs [58]. Yet, approximately 22% of respondents reported parental requests to continue AEDs influenced their decision.…”

“…Yet, approximately 22% of respondents reported parental requests to continue AEDs influenced their decision. This study suggests that professionals in epilepsy care that lack sufficient knowledge about PNES may be more likely to continue AEDs at a parent’s request [58]. These professionals may also be more likely to continue AEDs in order to facilitate acceptance of the diagnosis and/or to prevent a delay in psychological treatment [58].…”

“…This study suggests that professionals in epilepsy care that lack sufficient knowledge about PNES may be more likely to continue AEDs at a parent’s request [58]. These professionals may also be more likely to continue AEDs in order to facilitate acceptance of the diagnosis and/or to prevent a delay in psychological treatment [58]. This alternative, however, can cause a string of ethical and medical problems with lifelong consequences for the patient and family.…”

“…Parents may also wish to continue AEDs as a means to avoid social stigma associated with PNES, particularly at school. Additional factors that may impact a practitioner’s decision-making at time of withdrawing AEDs include whether mental health treatment is available and whether the practitioner has sufficient knowledge about PNES [58]. The clinician that complies with a request for continued AEDs risks substantially more harm to the patient and the patient’s family.…”