EEG Practices and Discontinuation of Antiseizure Medications in Pediatric Patients in the United States

Abstract

Background

Determination of optimal timing to discontinue antiseizure medication in seizure-free pediatric patients requires balancing seizure control with adverse antiseizure medication effects. Electroencephalogram (EEG) guides treatment decisions.

Methods

A survey was distributed among epilepsy providers in the United States via professional societies to identify antiseizure medication weaning criteria, influencing factors, and EEG utilization.

Results

Of 129 responses, 84% consider 2 years of seizure freedom before antiseizure medication withdrawal. Influencing factors include etiology (98%), patient/caregiver preferences (86%), seizure frequency (79%), medication side effects (70%), and patient age (63%). Eighty-two percent routinely conduct EEG before weaning, with routine EEG utilized most (57%). Abnormal EEG influenced 48% to avoid weaning antiseizure medication if EEG is abnormal, whereas (46%) incorporate additional considerations (eg, family discussions). Of those deferring weaning because of abnormal EEG, 70% repeat EEG within 1 year. Sixty-seven percent would not perform an EEG post-weaning if patient remains seizure-free.

Conclusions

Although EEG is crucial, multiple clinical factors guide antiseizure medication discontinuation.