Comparison of Acute Withdrawal and Slow Taper of Antiseizure Medications during Video Electroencephalographic Monitoring: Efficacy for Shortening of Hospital Stay

Motoki, Ayako; Akamatsu, Naoki; Fumuro, Tomoyuki; Miyoshi, Ayako; Tanaka, Hideaki; Hagiwara, Koichi; Ohara, Shuichi; Kamada, Takashi; Sekiya, Hiroshi; Murai, Hiroyuki

doi:10.3390/jcm10245972

Cited by 3 publications

(3 citation statements)

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“…All patients included in the study completed the LTM within 2–6 days, although 20 patients (26.7%) in the URW group and five patients (14.3%) in the RW group did not experience any seizures. The LTM duration for rapid taper and slow taper of medications was significantly different in prior studies, but did not reach significance in the present study ( p = 0.14) ( 16 , 19 ). The main reasons for the difference were the different taper protocols and limitation with regards to the LTM duration in our EMU.…”

Section: Discussioncontrasting

confidence: 86%

“…However, there is little published literature on the subject, and a better evidence base is needed to inform ASM reduction decisions in the EMU. Several studies have reported ASM tapering regimens for LTM ( 4 , 7 , 16 ), with few cases comparing seizure rates and adverse effects of slower versus faster discontinuation ( 17–19 ). Most studies used observational designs, and changes in patient populations and medication regimens make it difficult to extrapolate the utility and safety of different discontinuation rates from these studies.…”

Section: Discussionmentioning

confidence: 99%

“…Previous research tended to study patients who underwent slow or intermediate tapering rates of ASMs during LTM ( 2 , 4 , 8 , 9 , 20 ). However, in recent years more studies have reported on the rapid withdrawal of ASMs and even medication withdrawal at home, which aims to ensure the optimal use of EMU capacity, especially in the era of the coronavirus disease (COVID-19) pandemic ( 16 , 19 , 21–23 ). Therefore, in this study all ASMs were discontinued on admission for LTM in 75 patients, and the medications in the RW group were reduced by 50% daily in 35 patients.…”

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of rapid withdrawal of anti-seizure medication during long-term video-EEG monitoring

Liu

Deng

et al. 2023

Front. Neurol.

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ObjectiveAnti-seizure medications (ASMs) are often withdrawn during long-term video-EEG monitoring (LTM) to allow pre-surgical evaluation. Herein, we evaluated the safety and efficacy of ultra-rapid withdrawal (URW) and rapid withdrawal (RW) of ASMs in an epilepsy monitoring unit (EMU).MethodsThis retrospective study examined all consecutive patients admitted to our EMU between May 2021 and October 2022. Patients were classified into the URW and RW groups according to the way ASMs were withdrawn. We compared the efficacy and safety of the procedures used in the groups in terms of duration of LTM, latency to the first seizure, and incidence of focal to bilateral tonic–clonic seizures (FBTCS), seizure clusters (SC), and status epilepticus (SE).ResultsOverall, 110 patients (38 women) were included. The mean age of patients at the time of LTM was 29 years. All medications were stopped on admission for monitoring in the URW group (n = 75), while in the RW group (n = 35) ASMs were withdrawn within 1 day. In both groups, the duration of LTM was approximately 3 days: URW group (2.9 ± 0.5 days) and RW group (3.1 ± 0.8 days). The latency to the first seizure was significantly different between the two groups; however, there were no differences between the two groups in terms of the distribution of FBTCS, SC, or SE, number of seizures, and the requirement for intravenous rescue medication was low.ConclusionThe rapid withdrawal of ASMs to provoke seizures during monitoring for pre-surgical evaluation following the URW protocol was as effective and safe as with RW. Ultra-rapid ASM withdrawal has the benefits of reducing LTM duration and shortening the time to first seizure compared to rapid medication tapering.

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Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of rapid withdrawal of anti-seizure medication during long-term video-EEG monitoring

Liu

Deng

et al. 2023

Front. Neurol.

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Multifocal Epilepsy and Non-dominant Cingulate Lesion

Herlopian,

Gray,

Quraishi

2024

Epilepsy Surgery: A Practical Case-Based Approach

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Video-EEG-monitoring to guide antiseizure medication withdrawal

Dhaenens-Meyer,

Schriewer,

Weber

et al. 2023

Neurol. Res. Pract.

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Background Discontinuing anti-seizure medication (ASM) should be considered in persons with epilepsy with long-term seizure freedom. Clinicians should also pursue ASM withdrawal in persons with one-time seizures without increased recurrence risk and those with suspected non-epileptic events. However, ASM withdrawal is associated with the risk of recurring seizures. Monitored ASM withdrawal in an epilepsy monitoring unit (EMU) could help better evaluate the risk of seizure recurrence. Here, we investigate the practice of EMU-guided ASM withdrawal, assess its indications, and aim to determine positive and negative predictors for successful withdrawal. Methods We screened the medical records of all patients admitted to our EMU between November 1, 2019, and October 31, 2021, and included patients of at least 18 years admitted with the aim of permanent ASM withdrawal. We defined four groups of withdrawal indications: (1) long-term seizure freedom; (2) suspected non-epileptic events; (3) history of epileptic seizures but not fulfilling diagnostic criteria of epilepsy; and (4) seizure-freedom after epilepsy surgery. Successful withdrawal was defined according to the following criteria: no recoding of (sub)clinical seizure activity during VEM (groups 1, 2, and 3), patients did not meet the International League Against Epilepsy (ILAE) definition of epilepsy (groups 2 and 3) [14], and patients were discharged without ongoing ASM treatment (all groups). We also evaluated the prediction model by Lamberink et al. (LPM) for the risk of seizure recurrence in groups 1 and 3. Results 55/651 (8.6%) patients fulfilled the inclusion criteria. Withdrawal indications were distributed as follows; group 1: 2/55 (3.6%); group 2: 44/55 (80%); group 3: 9/55 (16,4%); group 4: 0/55. Overall, ASM withdrawal was successful in 90.9%. The sensitivity of the LPM for a 2-year 50% relapse risk threshold was 75%, the specificity 33.3%; for a 5-year relapse risk respectively 12.5% and 33.3%, suggesting that the model is not suitable for risk assessment in patients with one-time seizures or acute-symptomatic seizures, who constituted most of the evaluated patients. Conclusions Our study suggests that EMU-guided ASM withdrawal could be a helpful tool to support clinical decision-making and improve patient safety. Prospective, randomized trials should further evaluate this method in the future.

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Comparison of Acute Withdrawal and Slow Taper of Antiseizure Medications during Video Electroencephalographic Monitoring: Efficacy for Shortening of Hospital Stay

Cited by 3 publications

References 13 publications

Safety and efficacy of rapid withdrawal of anti-seizure medication during long-term video-EEG monitoring

Safety and efficacy of rapid withdrawal of anti-seizure medication during long-term video-EEG monitoring

Multifocal Epilepsy and Non-dominant Cingulate Lesion

Video-EEG-monitoring to guide antiseizure medication withdrawal

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