To characterize neurology health care professionals’ (HCPs) perceptions of convulsive seizure freedom and the relationship between antiepileptic drug (AED) adherence, AED half-life, and breakthrough seizures.

Convulsive seizures are a significant risk factor in sudden unexpected death in epilepsy (SUDEP), and a common reason for breakthrough seizures is missed AED doses. Long-half-life AEDs may protect against subtherapeutic drug levels in the event of a missed dose.

84 HCPs (general neurologists [51%], pediatric neurologists [20%], epileptologists [24%], nurse practitioners/physician assistants [6%]) completed the survey. 92% placed high importance (6 or 7 on a 7-point scale) on convulsive seizure freedom, yet only 31% defined acceptable seizure control as complete seizure freedom, and only 52% reported high familiarity with AAN/AES SUDEP guidelines. 73% believed missed doses were a common cause of breakthrough seizures and 80% indicated high concern about missed AED doses; however respondents believed that only 44% of their patients miss AED doses. 63% indicated that long–half-life AEDs were highly effective for minimizing breakthrough seizures resulting from missed doses, yet only 39% consider half-life when prescribing AEDs for newly diagnosed patients. Epileptologists were most concerned with achieving convulsive seizure freedom and most likely to consider half-life followed by general neurologists and pediatric neurologists.

HCPs were highly concerned about convulsive seizures and missed AED doses and agree that long–half-life AEDs mitigate the risk for breakthrough convulsive seizures. Most HCPs did not consider AED half-life when initially selecting an AED, possibly due to a willingness to accept occasional breakthrough seizures or a belief that patients do not miss AED doses. ºÃÉ«ÏÈÉú on AAN/AES SUDEP guidelines and strategies to prevent breakthrough seizures may decrease the burden of convulsive seizures.