Evidence map›Paper›PMID 40540761›Full record

ArticleEpilepsy research2025

Antiseizure medication discontinuation: A mixed-methods exploration of factors considered by patients when approaching decision-making.

Samuel W Terman, Jordan M Silva, Max Kuster, Jasper Lee, Amanda Brand, Kara Manuel, Navya Kalia, Micaela Dugan, Marla Reid, Katherine Mortati and 6 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Epilepsy research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
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

1 citing paper in PubMed.

  1. Article
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

16 authors.

Samuel W TermanUniversity of Michigan, Department of Neurology, Ann Arbor, MI, USA. Electronic address: sterman@umich.edu.
Jordan M SilvaUniversity of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: silvajor@med.umich.edu.
Max KusterState University of New York Downstate Health Sciences University Department of Neurology, Brooklyn, NY, USA. Electronic address: max.kuster@downstate.edu.
Jasper LeeHackensack Meridian School of Medicine, Nutley, NJ, USA. Electronic address: jasper.lee@hmhn.org.
Amanda BrandHackensack Meridian School of Medicine, Nutley, NJ, USA. Electronic address: amanda.brand@macaulay.cuny.edu.
Kara ManuelUniversity of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: kamanuel@med.umich.edu.
Navya KaliaUniversity of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: kalian@med.umich.edu.
Micaela DuganUniversity of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: duganmi@med.umich.edu.
Marla ReidState University of New York Downstate Health Sciences University Department of Neurology, Brooklyn, NY, USA. Electronic address: marla.reid@downstate.edu.
Katherine MortatiState University of New York Downstate Health Sciences University Department of Neurology, Brooklyn, NY, USA. Electronic address: katherine.mortati@downstate.edu.
Alexandra TolmasovState University of New York Downstate Health Sciences University Department of Neurology, Brooklyn, NY, USA. Electronic address: alexandra.tolmasov@downstate.edu.
Palak S PatelHackensack Meridian School of Medicine, Nutley, NJ, USA; John F Kennedy University Medical Center Departments of Neurology and Psychiatry, Edison, NJ, USA. Electronic address: palaks.patel@hmhn.org.
James F Burkethe Ohio State University, Department of Neurology, Columbus, OH, USA. Electronic address: james.burke@osumc.edu.
Arthur C GrantState University of New York Downstate Health Sciences University Department of Neurology, Brooklyn, NY, USA. Electronic address: arthur.grant@downstate.edu.
Susanna S O'KulaState University of New York Downstate Health Sciences University Department of Neurology, Brooklyn, NY, USA. Electronic address: susanna.okula@downstate.edu.
Chloe E HillUniversity of Michigan, Department of Neurology, Ann Arbor, MI, USA. Electronic address: chloehi@med.umich.edu.

Funding

Optimizing Care for Patients with Drug-Resistant EpilepsyK23NS126495 · NINDS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Chloe E Hill · 2023 to 2026
$881k
Optimizing antiseizure medication deprescribing decisions across the lifespan by integrating seizure risk prediction and patient preferences towards individualized net-benefit assessmentK23AG081463 · NIA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Samuel W Terman · 2024 to 2026
$588k
NIA NIH HHS K23 AG081463NINDS NIH HHS K23 NS126495
6 · The paper itself

Abstract

objectivesAntiseizure medications (ASMs) represent standard treatment for epilepsy. Yet, ASMs have adverse effects, and seizure risk decreases with longer seizure freedom. Guidelines consider ASM withdrawal after a period of seizure freedom. However, work exploring how patients approach this decision is scarce. We inquired what decision-making factors patients feel are relevant to ASM discontinuation.

methodsWe conducted a mixed-methods study of adults seen for epilepsy, at least one-year seizure-free, across three academic institutions. This included a semi-structured interview script assessing attitudes towards seizures, ASMs, and ASM discontinuation.

resultsWe interviewed 32 participants. Factors supporting ASM discontinuation included current side effects (e.g., dizziness, sedation), concern regarding long-term adverse effects, teratogenicity, inconvenience from taking and refilling prescriptions, feeling like seizure freedom demonstrated that they were 'cured', or low concern regarding seizure consequences. However, many reasons supported continued treatment, e.g., fear of seizures and their psychosocial consequences, little perceived downside to taking ASMs, or overall more substantial pros than cons. Patients noted that they might consider discontinuing ASMs if the medication was known to cause severe adverse effects (e.g., cancer), or if the doctor could guarantee seizure freedom post-discontinuation.

conclusionNumerous themes emerged including reasons favoring continued ASMs (e.g., fear of seizures and their psychosocial consequences, perceiving little downside to continued ASMs) but also many reasons against continued ASMs (e.g., side effects, inconvenience). Discussions surrounding how long to continue ASMs should be highly individualized given the heterogeneity of patient preferences regarding treatment and counseling.

Indexed as

AnticonvulsantsDecision MakingEpilepsySeizuresAdultAgedFemaleHumansMaleMiddle AgedYoung AdultAnticonvulsantsAntiseizure medicationsDecision-makingDiscontinuationEpilepsyMixed methods

Identifiers

PMID40540761
PMCPMC12849773

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.