Abstract Details

Title Utility in Application of Provocative Technique in the Epilepsy Monitoring Unit: An Analysis of Weaning Antiepileptic Medications

Topic Epilepsy

Presentation(s) P06 - (-)

Poster/Presentation
Number 170

Objective

Background BACKGROUND: AEDs are often weaned on EMU admission, yet the medical literature sparsely addresses to what degree weaning enhances diagnostic yield. The recently published Institute of Medicine report proposes that improvement of epilepsy patient care should include optimizing epilepsy center diagnostics. Weaning AEDs could improve EMU diagnostic success and, thus, optimize EMU services and reduce healthcare costs through shortening LOS.

Design/Methods DESIGN/METHODS: This is a retrospective review of consecutive diagnostic adult EMU admissions to Wake Forest Baptist Health Comprehensive Epilepsy Center. Pre-surgical admissions were excluded. 108 patients taking AEDs on admission were identified. Review of hospital records determined discharge diagnosis, AED weaning, timing of weaning, days to first event (DTE), and LOS. Early AED weaning (EWAED) was defined as 50% reduction of one AED on admission.

Results RESULTS: 65.8% (n=73) of weaned patients and 85.7% (n=35) of non-weaned patients (p=0.03) had events. There was no difference in weaning eliciting epileptic versus non-epileptic events (p=0.49). EWAED did not increase the rate of event capture (67.6%), however, EWAED exhibited a trend towards reducing DTE (0.96 versus 2.08 days [p=0.49]) and especially shortened DTE for epileptic events (0.56 versus 2.18 days). EWAED was associated with shorter LOS when events were captured (2.43 versus 4.04 days). One adverse seizure-related event occurred, and the affected patient did not undergo EWAED.

Conclusions CONCLUSIONS: Weaning AEDs successfully provokes EMU events, and selective EWAED reduces DTE and LOS. Suspicion for non-epileptic diagnosis and high baseline event frequency likely guided decisions that some patients would not be weaned. Larger, prospective studies are needed to develop recommendations for AED weaning protocols in combination with other provocative techniques.

Authors/Disclosures
Nathan Wyatt, MD (Chattanooga Neurology Associates) PRESENTER	No disclosure on file
Jane Boggs, MD (Wake Forest University neurology)	The institution of Dr. Boggs has received research support from Liva Nova. Dr. Boggs has a non-compensated relationship as a Chairman PAB with Epilepsy Alliance North Carolina that is relevant to AAN interests or activities.
Cheryl Bushnell, MD, MHS (Wake Forest School of Medicine)	The institution of Dr. Bushnell has received research support from PCORI. The institution of Dr. Bushnell has received research support from NIH/NINDS. Dr. Bushnell has received intellectual property interests from a discovery or technology relating to health care. Dr. Bushnell has received publishing royalties from a publication relating to health care.
	No disclosure on file

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