Frequency of and factors associated with antiseizure medication discontinuation discussions and decisions in patients with epilepsy: A multicenter retrospective chart review.
Frequency of and factors associated with antiseizure medication discontinuation discussions and decisions in patients with epilepsy: A multicenter retrospective chart review.
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DOI：
10.1002/epi4.12695
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发表时间：
2023-06
期刊：
影响因子：
3
通讯作者：
Braun, Kees P. J.
中科院分区：
文献类型：
--
作者：
Terman, Samuel W.;Slinger, Geertruida;Koek, Adriana;Skvarce, Jeremy;Springer, Mellanie V.;Ziobro, Julie M.;Burke, James F.;Otte, Willem M.;Thijs, Roland D.;Braun, Kees P. J.
指南建议在无癫痫发作的癫痫患者中考虑停用抗癫痫药物。在实践中，人们对如何作出中止决定知之甚少。我们测量了围绕ASM终止的讨论和决策的频率以及与之相关的因素。我们在密歇根大学（UM）和两个荷兰中心：威廉敏娜儿童医院（WCH）和荷兰癫痫治疗中心（SEIN）进行了一项多中心回顾性队列研究。我们筛选了2015年1月门诊癫痫就诊的所有儿童和成人，包括在随后的2年内至少就诊一次且至少一年无癫痫发作的儿童和成人。我们记录图表是否记录了(1)与患者关于可能停止ASM的讨论和(2)任何计划停止至少一个ASM的尝试。我们进行了多水平逻辑回归来确定与每个结果相关的因素。我们纳入了来自463名患者的1058次就诊。在所有至少一年无癫痫发作的患者中，248/463（53%）有任何讨论的记录，98/463（21%）计划至少停止一次ASM。至少2年无癫痫发作的患者相应频率分别为184/285（65%）和74/285（26%）。讨论或停止治疗的可能性随着癫痫发作自由持续时间的延长而增加。尽管如此，即使对于10年无癫痫发作的患者，我们的模型预测，只有49%的就诊记录中有停药讨论，只有16%的就诊决定停药。提供者之间的差异解释了18%的患者是否停止任何ASM的差异。只有大约一半的长时间癫痫发作自由的患者有关于ASM停药的记录讨论。即使在低风险患者中，停药也相当罕见。未来的工作应进一步探讨障碍和促进咨询和中止尝试。
Guidelines 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. We 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. We 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. 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.
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