ArticleEpilepsia2025
Non-discontinuation of antiseizure medication in seizure-free patients with epilepsy: Reasons and predictors among neurologists and patients.
Article in Epilepsia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
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10 authors.
Funding
Abstract
objectiveThis study was undertaken to investigate clinical and psychosocial factors associated with antiseizure medication (ASM) non-discontinuation in seizure-free patients with epilepsy among both neurologists and patients.
methodsIn this cross-sectional study, neurologists documented their recommendations on ASM discontinuation (comprising both complete discontinuation and ≥25% dose reduction) in patients aged ≥18 years who had been seizure-free for at least 2 years. Based on these recommendations, patients made individual decisions. In both neurologists and patients, reasons for and predictors of ASM non-discontinuation were assessed considering demographic and epilepsy-related variables as well as standardized psychosocial questionnaires.
resultsAmong 196 patients (53.1% female, median age = 50 years, interquartile range [IQR] = 36-61; median seizure-free duration = 6 years, IQR = 4-11), neurologists recommended ASM discontinuation in 110 cases (56.1%), of which 29 patients (26.4%) agreed. Neurologists were more likely to favor ASM non-discontinuation if they had fewer years of professional experience (odds ratio [OR] = .96, 95% confidence interval [CI] = .92-.99) and if patients had shorter seizure-free durations (OR = .98, 95% CI = .98-.99). Among patients, longer seizure-free duration (OR = 1.01, 95% CI = 1.01-1.02) and a history of generalized or focal to bilateral tonic-clonic seizures (OR = 2.72, 95% CI = 1.15-6.43) were independently associated with ASM non-discontinuation. Excluding the 27 patients who favored a dose reduction, ASM non-discontinuation was still associated with a longer duration of seizure freedom (OR = 1.02, 95% CI = 1.01-1.03). Further predictors were higher anxiety scores (OR = 1.37, 95% CI = 1.05-1.78) and better ASM tolerability (OR = 1.04, 95% CI = 1.01-1.07). SIGNIFICANCE: Neurologists and, even more so, patients are hesitant to discontinue ASM, which was accomplished in only 15% of seizure-free patients. Duration of seizure freedom has a major impact on the decision but in opposite directions comparing both groups. Understanding these differing perspectives is essential to improve shared decision-making on this complex issue in epilepsy care.
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