Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 19.
doi: 10.1111/epi.18464. Online ahead of print.

Risk of unprovoked seizures after discontinuation of antiseizure medication at discharge following acute symptomatic seizures

Vineet Punia  1 , MarieElena Byrnes  1 , Nicolas R Thompson  2   3 , Neishay Ayub  4 , Clio Rubinos  5 , Sahar Zafar  6 , Adithya Sivaraju  7 ; PASSION (Post‐Acute Symptomatic Seizure Investigation and Outcomes Network) investigators
Affiliations

Risk of unprovoked seizures after discontinuation of antiseizure medication at discharge following acute symptomatic seizures

Vineet Punia et al. Epilepsia. .

Abstract

Objective: We aimed to investigate whether the risk of unprovoked seizures differs between patients receiving a brief antiseizure medication (ASM) course during hospitalization and those treated beyond hospital discharge following acute symptomatic seizures (ASyS).

Methods: We performed a single-center, retrospective cohort study of all consecutive adults without epilepsy who received maintenance ASM (≥48 h) after ASyS. All patients underwent continuous electroencephalographic (EEG) monitoring and were divided into those receiving ASMs only during hospitalization and those discharged on ASMs. We used propensity score matching to balance covariates between groups. Cause-specific Cox proportional hazards models analyzed the time to the first unprovoked seizure; death was treated as a competing risk.

Results: A total of 144 adults (mean age = 57.4 ± 18.6 years, 48% females) included 118 (82%) patients discharged on ASMs and 26 (18%) who received ASM during hospitalization. During a median follow-up of 24.6 months, 15% experienced an unprovoked seizure. The cumulative incidence of unprovoked seizures at 3, 12, and 36 months was 7.2%, 11.5%, and 17.9%, respectively. ASM status at discharge was significantly associated with electrographic seizures on EEG, etiology, mental status at the time of ASyS, and functional outcome at discharge. After a well-balanced propensity score matching, there was no significant difference in time to unprovoked seizure between patients discharged on ASMs and those who received ASMs only during hospitalization.

Significance: We found that unprovoked seizure risk may not differ significantly between ASyS patients receiving a brief ASM course during hospitalization and those treated for a longer duration after discharge. Although our findings need confirmation in larger studies, they underscore the need for investigating optimal ASM duration in this patient population.

Keywords: continuous EEG; epileptogenesis; late onset seizure; propensity matching; symptomatic epilepsy.

PubMed Disclaimer

Similar articles

See all similar articles

References

REFERENCES

    1. Hauser WA, Annegers JF, Rocca WA. Descriptive epidemiology of epilepsy: contributions of population‐based studies from Rochester, Minnesota. Mayo Clin Proc. 1996;71(6):576–586.
    1. Annegers JF, Hauser WA, Lee JR, Rocca WA. Incidence of acute symptomatic seizures in Rochester, Minnesota, 1935‐1984. Epilepsia. 1995;36(4):327–333.
    1. Mauritz M, Hirsch LJ, Camfield P, Chin R, Nardone R, Lattanzi S, et al. Acute symptomatic seizures: an educational, evidence‐based review. Epileptic Disord Int Epilepsy J Videotape. 2022;24(1):26–49.
    1. Holtkamp M, Beghi E, Benninger F, Kälviäinen R, Rocamora R, Christensen H. European stroke organisation guidelines for the management of post‐stroke seizures and epilepsy. Eur Stroke J. 2017;2(2):103–115.
    1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American stroke. Stroke. 2019;50(12):e344–e418.

LinkOut - more resources