ArticleAnnals of clinical and translational neurology2025
Management and Outcomes in Confirmed or Suspected Acute Symptomatic Seizure: Role of Structured Outpatient Care.
Article in Annals of clinical and translational neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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11 authors.
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Abstract
objectivePost-discharge management and outcomes of acute symptomatic seizures (ASyS) remain underexplored. We analyzed post-discharge ASM management and outcomes in ASyS patients undergoing continuous EEG (cEEG), including the role of outpatient care through a post-acute symptomatic seizure (PASS) clinic.
methodsWe performed a single-center, retrospective study of adults without epilepsy discharged on ASMs due to witnessed or suspected ASyS in 2019. A cause-specific cumulative distribution function was used to estimate outcome probabilities, and cause-specific Cox proportional hazards models examined factors influencing the first ASM discontinuation, subsequent unprovoked seizure, and death.
resultsThe study evaluated 307 patients [mean 61.6 years; 51.8% females], 60.2% with confirmed ASyS [144 (46.9%) clinical ASyS; 41 (13.4%) with electrographic ASyS only]. During median 14-month follow-up, 31.9% discontinued ASM, 18.6% experienced unprovoked seizure, and 38.4% died. Based on cumulative incidence function, ASM discontinuation, unprovoked seizure, and death at 12 months occurred in 26.2%, 14.1%, and 29.3% of patients, respectively. 59.6% of alive patients without unprovoked seizures were taking ASMs. Clinical ASyS (HR 0.48; 95% CI 0.31, 0.76), electrographic ASyS only (HR 0.37; 0.17, 0.82), and acute epileptiform abnormalities (HR 0.48; 0.27, 0.84) were associated with lower ASM discontinuation. Unprovoked seizures were associated with epileptiform outpatient EEG (HR 5.40; 2.62, 11.12). PASS clinic patients discontinued ASMs 74% faster (HR 1.74; 1.12, 2.71), with 88% lower risk of unprovoked seizures (HR 0.12; 0.04, 0.34).
interpretationOutpatient ASM overuse in ASyS patients is common. Outpatient epileptiform abnormalities may predict unprovoked seizures. Structured outpatient care, such as PASS clinics, facilitates faster yet safer ASM discontinuation.
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