Early withdrawal of non-anesthetic antiepileptic drugs after successful termination of nonconvulsive seizures and nonconvulsive status epilepticus.


Journal Article

PURPOSE: Multiple antiepileptic drugs (AEDs) are often necessary to treat nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE). AED polypharmacy places patients at risk for adverse side effects and drug-drug interactions. Identifying the likelihood of seizure relapse when weaning non-anesthetic AEDs may provide guidance in the critical care unit. METHOD: Ninety-nine adult patients with successful treatment of electrographic-proven NCS or NCSE on continuous critical care EEG (CCEEG) monitoring were identified retrospectively. Patients were determined to undergo an AED wean if the number of non-anesthetic AEDs was reduced at the time of discharge compared to the number of non-anesthetic AEDs at primary seizure cessation. Primary outcome was recurrent seizures either clinically or by CCEEG during hospitalization. Secondary outcome measures included hospital length of stay and discharge disposition. RESULTS: The rate of recurrent seizures in the wean group was not statistically different when compared to the group that did not undergo an AED wean (17% vs. 13%, respectively; p = 0.77). The wean group had a median value of 4 (IQR: 3-4) non-anesthetic AEDs at the time of primary seizure cessation compared with 3 (IQR: 2-3) in the non-wean group (p < 0.0001). However, both groups had similar values of AEDs at discharge (median of 2 (IQR: 2-3) vs. 3 (IQR: 2-3) for wean and non-wean groups respectively; p = 0.40). Discharge disposition (favorable, acceptable, or unfavorable) was similar between groups (p = 0.32). CONCLUSIONS: Early weaning of non-anesthetic AEDs does not increase the risk of recurrent seizures in patients treated for NCS or NCSE during their hospitalization.

Full Text

Duke Authors

Cited Authors

  • Creed, JA; Son, J; Farjat, AE; Swisher, CB

Published Date

  • January 2018

Published In

Volume / Issue

  • 54 /

Start / End Page

  • 45 - 50

PubMed ID

  • 29248799

Pubmed Central ID

  • 29248799

Electronic International Standard Serial Number (EISSN)

  • 1532-2688

Digital Object Identifier (DOI)

  • 10.1016/j.seizure.2017.12.001


  • eng

Conference Location

  • England