EEG practices and discontinuation of anti-seizure medications in people with epilepsy: A cross-sectional survey in the Eastern Mediterranean region.

Overview

PURPOSE: To explore clinical practices in the Eastern Mediterranean regarding EEG utilization and anti-seizure medication (ASM) weaning in people with epilepsy. METHODS: An anonymous online survey was distributed to adult and pediatric neurologists and epileptologists in the Middle East region, assessing professional background, ASM weaning criteria, EEG utilization, and decision-making influences. Descriptive analysis was used to identify regional patterns. RESULTS: Seventy-three neurologists and epileptologists responded. The majority (82 %) considered a minimum of two years of seizure freedom before ASM discontinuation. Key factors influencing this decision included epilepsy etiology (93 %), seizure-free duration (90 %), and diagnostic findings (85 %). EEG was routinely obtained pre-weaning by 86 % of clinicians, with frequent epileptiform discharges being the most significant deterrent to withdrawal (80 %). While EEG access was high (83 % routine access), tapering strategies and post-weaning monitoring varied. A slow taper over 3-6 months was favored by 41 %, while 72 % did not perform routine follow-up EEG. CONCLUSIONS: Clinicians in the Eastern Mediterranean align with international standards for ASM weaning, heavily relying on EEG for risk stratification. However, significant variability in tapering and follow-up practices highlights a need for greater standardization to optimize patient care and resource use.