Frequency of and factors associated with antiseizure medication discontinuation discussions and decisions in patients with epilepsy: A multicenter retrospective chart review.

Autor: Terman SW; University of Michigan Department of Neurology, Ann Arbor, Michigan, USA., Slinger G; Department of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, member of ERN EpiCare, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands., Koek A; University of Michigan Department of Neurology, Ann Arbor, Michigan, USA., Skvarce J; University of Michigan Medical School, Ann Arbor, Michigan, USA., Springer MV; University of Michigan Department of Neurology, Ann Arbor, Michigan, USA., Ziobro JM; University of Michigan Department of Pediatrics, Ann Arbor, Michigan, USA., Burke JF; Ohio State University Department of Neurology, Columbus, Ohio, USA., Otte WM; Department of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, member of ERN EpiCare, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands., Thijs RD; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.; Department of Neurology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands.; Queen Square Institute of Neurology, University College London, London, UK., Braun KPJ; Department of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, member of ERN EpiCare, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
Jazyk: angličtina
Zdroj: Epilepsia open [Epilepsia Open] 2023 Jun; Vol. 8 (2), pp. 371-385. Date of Electronic Publication: 2023 Feb 14.
DOI: 10.1002/epi4.12695
Abstrakt: Objective: Guidelines suggest considering antiseizure medication (ASM) discontinuation in patients with epilepsy who become seizure-free. Little is known about how discontinuation decisions are being made in practice. We measured the frequency of, and factors associated with, discussions and decisions surrounding ASM discontinuation.
Methods: We performed a multicenter retrospective cohort study at the University of Michigan (UM) and two Dutch centers: Wilhelmina Children's Hospital (WCH) and Stichting Epilepsie Instellingen Nederland (SEIN). We screened all children and adults with outpatient epilepsy visits in January 2015 and included those with at least one visit during the subsequent 2 years where they were seizure-free for at least one year. We recorded whether charts documented (1) a discussion with the patient about possible ASM discontinuation and (2) any planned attempt to discontinue at least one ASM. We conducted multilevel logistic regressions to determine factors associated with each outcome.
Results: We included 1058 visits from 463 patients. Of all patients who were seizure-free at least one year, 248/463 (53%) had documentation of any discussion and 98/463 (21%) planned to discontinue at least one ASM. Corresponding frequencies for patients who were seizure-free at least 2 years were 184/285 (65%) and 74/285 (26%). The probability of discussing or discontinuing increased with longer duration of seizure freedom. Still, even for patients who were 10 years seizure-free, our models predicated that in only 49% of visits was a discontinuation discussion documented, and in only 16% of visits was it decided to discontinue all ASMs. Provider-to-provider variation explained 18% of variation in whether patients discontinued any ASM.
Significance: Only approximately half of patients with prolonged seizure freedom had a documented discussion about ASM discontinuation. Discontinuation was fairly rare even among low-risk patients. Future work should further explore barriers to and facilitators of counseling and discontinuation attempts.
(© 2023 The Authors. Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)
Databáze: MEDLINE
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