Evidence map›Paper›PMID 36693718›Full record

ArticleEpilepsia open2023

Frequency of and factors associated with antiseizure medication discontinuation discussions and decisions in patients with epilepsy: A multicenter retrospective chart review.

Samuel W Terman, Geertruida Slinger, Adriana Koek, Jeremy Skvarce, Mellanie V Springer, Julie M Ziobro, James F Burke, Willem M Otte, Roland D Thijs, Kees P J Braun

Open access · goldAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Epilepsia open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
2.4field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 11 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 3 countries.

Samuel W TermanUniversity of Michigan Department of Neurology, Ann Arbor, Michigan, USA.ORCID 0000-0001-6179-9467
Geertruida SlingerDepartment of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, member of ERN EpiCare, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.ORCID 0000-0002-3656-8795
Adriana KoekUniversity of Michigan Department of Neurology, Ann Arbor, Michigan, USA.
Jeremy SkvarceUniversity of Michigan Medical School, Ann Arbor, Michigan, USA.
Mellanie V SpringerUniversity of Michigan Department of Neurology, Ann Arbor, Michigan, USA.
Julie M ZiobroUniversity of Michigan Department of Pediatrics, Ann Arbor, Michigan, USA.
James F BurkeOhio State University Department of Neurology, Columbus, Ohio, USA.
Willem M OtteDepartment of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, member of ERN EpiCare, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.ORCID 0000-0003-1511-6834
Roland D ThijsStichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
Kees P J BraunDepartment of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, member of ERN EpiCare, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
University of Michigan · USUtrecht University · NLLeiden University Medical Center · NLThe Ohio State University · US

Funding

Michigan Institute for Clinical and Health Research (MICHR)UL1TR002240 · NCATS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI LUMENG, JULIE C, MASHOUR, GEORGE ALEXANDER · 2017 to 2022
$54.9M
Michigan Institute for Clinical and Health Research (MICHR)UM1TR004404 · NCATS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Julie C Lumeng · 2023 to 2026
$39.8M
U.S. Deprescribing Research NetworkR24AG064025 · NIA · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · PI BOYD, CYNTHIA MELINDA, STEINMAN, MICHAEL A. · 2019 to 2023
$9.9M
Partnering with an Urban Safety Net Hospital to Deliver Stroke Preparedness in the Emergency DepartmentK01NS117555 · NINDS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI SPRINGER, MELLANIE V · 2020 to 2024
$1.2M
NCATS NIH HHS UL1 TR002240NCATS NIH HHS UM1 TR004404NIA NIH HHS R24 AG064025NINDS NIH HHS K01 NS117555
6 · The paper itself

Abstract

objectiveGuidelines suggest considering antiseizure medication (ASM) discontinuation in patients with epilepsy who become seizure-free. Little is known about how discontinuation decisions are being made in practice. We measured the frequency of, and factors associated with, discussions and decisions surrounding ASM discontinuation.

methodsWe performed a multicenter retrospective cohort study at the University of Michigan (UM) and two Dutch centers: Wilhelmina Children's Hospital (WCH) and Stichting Epilepsie Instellingen Nederland (SEIN). We screened all children and adults with outpatient epilepsy visits in January 2015 and included those with at least one visit during the subsequent 2 years where they were seizure-free for at least one year. We recorded whether charts documented (1) a discussion with the patient about possible ASM discontinuation and (2) any planned attempt to discontinue at least one ASM. We conducted multilevel logistic regressions to determine factors associated with each outcome.

resultsWe included 1058 visits from 463 patients. Of all patients who were seizure-free at least one year, 248/463 (53%) had documentation of any discussion and 98/463 (21%) planned to discontinue at least one ASM. Corresponding frequencies for patients who were seizure-free at least 2 years were 184/285 (65%) and 74/285 (26%). The probability of discussing or discontinuing increased with longer duration of seizure freedom. Still, even for patients who were 10 years seizure-free, our models predicated that in only 49% of visits was a discontinuation discussion documented, and in only 16% of visits was it decided to discontinue all ASMs. Provider-to-provider variation explained 18% of variation in whether patients discontinued any ASM. SIGNIFICANCE: Only approximately half of patients with prolonged seizure freedom had a documented discussion about ASM discontinuation. Discontinuation was fairly rare even among low-risk patients. Future work should further explore barriers to and facilitators of counseling and discontinuation attempts.

Indexed as

EpilepsyStatus EpilepticusAdultAnticonvulsantsChildHumansRetrospective StudiesRiskAnticonvulsantsantiseizure medicationdecision-makingdrug withdrawalepilepsy

Identifiers

PMID36693718
PMCPMC10235583
OpenAlexW4318025245

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.