Abstract Details

Title Anti-seizure medication use in hospitalized patients undergoing continuous EEG monitoring: A multicenter validation study

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 9-012

Objective To determine the predictors of ASM initiation and continuation after discharge in those undergoing cEEG.

Background Studies have shown that continuous EEG (cEEG) monitoring leads to an increase in the use of anti-seizure medications (ASM) in hospitalized patients. However, the factors leading to ASM use in these patients are not clearly identified.

Design/Methods We performed a retrospective study of hospitalized patients (age >18 years) who underwent cEEG between 07/01- 09/30/2021 at five centers. Patients with history of epilepsy were excluded. ASM initiation was defined as treatment for > 48 hours during hospitalization. ASM continuation was defined as ASM prescription at discharge. Multivariable logistic regression models were developed to determine predictors of ASM initiation and ASM continuation using data from three centers (derivation cohort). The models were validated externally using data from the remaining two centers (validation cohort).

Results

Among 1,030 patients (median age 64, 55.1% females), 528 (51.2%) were started on ASM and 288 (27.9%) were discharged on ASMs. On multivariable analysis, predictors of ASM initiation included progressive brain injury (odds ratio [OR] 2.38; 95% CI 1.08-5.49), traumatic brain injury (TBI) (OR 6.38; 95% CI 2.39- 20.5), clinical acute symptomatic seizure (ASyS) (OR 16.5; 95% CI 9.11- 31.1), EEG ASyS (OR 30.3; 95% CI 8.18-15.7), and lateralized periodic discharges (LPDs) (OR 9.38; 95% CI 1.86-74.6). Area under the curve (AUC) of the model for ASM initiation was 0.90 and 0.85 in the derivation and validation cohorts, respectively. The predictors of ASM continuation included all of the above variables except TBI and LPDs, with AUC of 0.96 and 0.89 in the derivation and validation cohorts, respectively.

Conclusions Patients with progressive brain injury, clinical ASyS, or EEG ASyS are more likely to be treated and discharged on ASM. Further studies are required to study the impact of ASM use on outcomes.

Authors/Disclosures
Natalie K. Erlich-Malona, MD (Neurology Department, UMass Memorial Medical Center) PRESENTER	Dr. Erlich-Malona has nothing to disclose.
Neishay Ayub, MD (Brown Neurology)	The institution of Dr. Ayub has received research support from Brown Physicians Incorporated. The institution of Dr. Ayub has received research support from Pappitto Opportunity Connection.
Hunter Rice	Mr. Rice has nothing to disclose.
Fernando H. Ibanhes, MD (USC Neurology Residency Program)	Mr. Ibanhes has nothing to disclose.
Mohammad N. Haider (University At Buffalo, SUNY)	Mr. Haider has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Blink TBI. Mr. Haider has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Blink CNS. Mr. Haider has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Oculogica Inc. Mr. Haider has stock in Headquarters Health. The institution of Mr. Haider has received research support from NIH. Mr. Haider has received research support from Headquarters Health. The institution of Mr. Haider has received research support from CDMRP/PRMRP.
Clio A. Rubinos, MD, MSCR (University of North Carolina)	Dr. Rubinos has nothing to disclose.
Adithya Sivaraju, MD (Yale New Haven Medical Center)	Dr. Sivaraju has nothing to disclose.
Vineet Punia, MD (Cleveland Clinic)	Dr. Punia has nothing to disclose.
Sahar Zafar, MD	Dr. Zafar has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Zafar has received research support from NIH. Dr. Zafar has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker for a lecture with Marinus.
Monica B. Dhakar, MBBS (Xenon Pharmaceuticals)	Dr. Dhakar has received personal compensation for serving as an employee of Xenon Pharmaceuticals Inc. Dr. Dhakar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell Inc. Dr. Dhakar has or had stock in Xenon Pharmaceuticals Inc. The institution of an immediate family member of Dr. Dhakar has received research support from NIH. The institution of an immediate family member of Dr. Dhakar has received research support from Medtronics.

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