Development of a rapid screener to elicit patient preferences for antiseizure medication discontinuation

While guidelines encourage individualized discussions of the risks and benefits of antiseizure medication (ASM) withdrawal after a period of seizure-freedom, no formal methods exist for assessing patient preferences. We report the initial development of a rapid patient preferences screener.

We conducted a mixed-methods study of adults who were ≥1 year seizure-free and seen for epilepsy across three institutions. We reviewed existing questionnaires and adapted three questions measuring core constructs influencing ASM decisions - views about ASMs, driving restrictions, and seizures. We added one additional "global" question, for 4 total questions. Participants rated question clarity and utility from 1 (low) to 7 (high).

Of 32 participants, the median patient age was 46 (interquartile range [IQR] 33-56), with a median 3 years since their last seizure (IQR 2-11). Median responses were: 2 (IQR 1-5) for being bothered by ASMs, 2 (IQR 1-6) for feeling that a driving restriction would be disruptive, and 5 (IQR 4-7) for feeling that another seizure would be serious. Respondents tended to disagree that ASMs are doing more harm than good (median 1, IQR 1-2). Participants rated question clarity (median 6, IQR 6-7) and utility (median 7, IQR 6-7) highly.

We report the initial development of a pre-visit rapid screener of patient preferences pertinent to ASM withdrawal in well-controlled epilepsy. Patients endorsed the utility of such a screener and provided guidance to improve items. We hope that this work will ultimately improve shared decision-making.