TY - JOUR
T1 - Antiseizure Medication Withdrawal Practice Patterns
T2 - A Survey among Members of the American Academy of Neurology and EpiCARE
AU - Terman, Samuel W.
AU - Slinger, Geertruida
AU - Rheaume, Carol E.
AU - Haque, Anisa S.
AU - Smith, Shawna N.
AU - Van Griethuysen, Renate
AU - Van Asch, Charlotte J.J.
AU - Otte, Willem M.
AU - Burke, James F.
AU - Braun, Kees P.J.
N1 - Funding Information:
S.W. Terman is supported by the Susan S Spencer Clinical Research Training Scholarship and the Michigan Institute for Clinical and Health Research J Award UL1TR002240. G. Slinger is supported by the friends UMC Utrecht/MING Fund. C.E. Rheaume is employed by the American Academy of Neurology. A.S. Haque and S.N. Smith report no relevant funding. R. van Griethuysen is supported by the friends UMC Utrecht/MING Fund. C.J.J. van Asch reports no relevant funding. W.M. Otte is supported by the friends UMC Utrecht/MING Fund. J.F. Burke is supported by National Institute of Neurological Disorders and Stroke K08 NS082597 and NIH National Institute on Minority Health and Health Disparities R01 MD008879. K.P.J. Braun is supported by the friends UMC Utrecht/MING Fund.
Publisher Copyright:
© American Academy of Neurology.
PY - 2023/2/13
Y1 - 2023/2/13
N2 - BACKGROUND AND OBJECTIVES: To describe neurologist practice patterns, challenges, and decision support needs pertaining to withdrawal of antiseizure medications (ASMs) in patients with well-controlled epilepsy.METHODS: We sent an electronic survey to (1) US and (2) European physician members of the American Academy of Neurology and (3) members of EpiCARE, a European Reference Network for rare and complex epilepsies. Analyses included frequencies and percentages, and we showed distributions through histograms and violin plots.RESULTS: We sent the survey to 4,923 individuals; 463 consented, 411 passed eligibility questions, and 287 responded to at least 1 of these questions. Most respondents indicated that they might ever consider ASM withdrawal, with respondents treating mostly children being more likely ever to consider withdrawal (e.g., medical monotherapy: children 96% vs adults 81%;
p < 0.05). The most important factors when making decisions included seizure probability (83%), consequences of seizures (73%), and driving (74%). The top challenges when making decisions included unclear seizure probability (81%), inadequate guidelines (50%), and difficulty communicating probabilities (45%). Respondents would consider withdrawal after a median of 2-year seizure freedom, but also responded that they would begin withdrawal on average only when the postwithdrawal seizure relapse risk in the coming 2 years was less than 15%-30%. Wide variation existed in the use of words or numbers in respondents' counsel methods, for example, percentages vs frequencies or probability of seizure freedom vs seizure. The most highly rated point-of-care methods to inform providers of calculated risk were Kaplan-Meier curves and showing percentages only, rather than pictographs or text recommendations alone.
DISCUSSION: Most surveyed neurologists would consider withdrawing ASMs in seizure-free individuals. Seizure probability was the largest factor driving decisions, yet estimating seizure probabilities was the greatest challenge. Respondents on average indicated that they may withdraw ASM after a minimum seizure-free duration of 2 years, yet also on average were willing to withdraw when seizure risk decreased below 15%-30%, which is lower than most patients' postwithdrawal risk at 2-year seizure freedom and lower than the equivalent even of a first seizure of life. These findings will inform future efforts at developing decision support tools aimed at optimizing ASM withdrawal decisions.
AB - BACKGROUND AND OBJECTIVES: To describe neurologist practice patterns, challenges, and decision support needs pertaining to withdrawal of antiseizure medications (ASMs) in patients with well-controlled epilepsy.METHODS: We sent an electronic survey to (1) US and (2) European physician members of the American Academy of Neurology and (3) members of EpiCARE, a European Reference Network for rare and complex epilepsies. Analyses included frequencies and percentages, and we showed distributions through histograms and violin plots.RESULTS: We sent the survey to 4,923 individuals; 463 consented, 411 passed eligibility questions, and 287 responded to at least 1 of these questions. Most respondents indicated that they might ever consider ASM withdrawal, with respondents treating mostly children being more likely ever to consider withdrawal (e.g., medical monotherapy: children 96% vs adults 81%;
p < 0.05). The most important factors when making decisions included seizure probability (83%), consequences of seizures (73%), and driving (74%). The top challenges when making decisions included unclear seizure probability (81%), inadequate guidelines (50%), and difficulty communicating probabilities (45%). Respondents would consider withdrawal after a median of 2-year seizure freedom, but also responded that they would begin withdrawal on average only when the postwithdrawal seizure relapse risk in the coming 2 years was less than 15%-30%. Wide variation existed in the use of words or numbers in respondents' counsel methods, for example, percentages vs frequencies or probability of seizure freedom vs seizure. The most highly rated point-of-care methods to inform providers of calculated risk were Kaplan-Meier curves and showing percentages only, rather than pictographs or text recommendations alone.
DISCUSSION: Most surveyed neurologists would consider withdrawing ASMs in seizure-free individuals. Seizure probability was the largest factor driving decisions, yet estimating seizure probabilities was the greatest challenge. Respondents on average indicated that they may withdraw ASM after a minimum seizure-free duration of 2 years, yet also on average were willing to withdraw when seizure risk decreased below 15%-30%, which is lower than most patients' postwithdrawal risk at 2-year seizure freedom and lower than the equivalent even of a first seizure of life. These findings will inform future efforts at developing decision support tools aimed at optimizing ASM withdrawal decisions.
UR - http://www.scopus.com/inward/record.url?scp=85148455178&partnerID=8YFLogxK
U2 - 10.1212/CPJ.0000000000200109
DO - 10.1212/CPJ.0000000000200109
M3 - Article
C2 - 37063781
AN - SCOPUS:85148455178
SN - 2163-0402
VL - 13
JO - Neurology: Clinical Practice
JF - Neurology: Clinical Practice
IS - 1
M1 - e200109
ER -