Antiseizure medications in children with acute symptomatic seizures: A quality improvement project

There is a dearth of literature about the duration of treatment with antiseizure medications (ASM) of children after acute symptomatic seizures (ASyS). Our goal was to explore the impact of a quality improvement (QI) project on the use of regular ASM in children after ASyS admitted in a quaternary paediatric hospital.

This was a retrospective study over the period 2022-2024. As per our QI project, we introduced a plan during patient admission to start weaning or consider weaning ASM, if this was deemed to be clinically appropriate. The QI was implemented over the period June 2023-October 2023. Eligible patients (0-18 years) were identified through the electronic patient record and were divided into 2 groups: Group A (prior to the quality improvement project) and Group B (after the quality improvement project). The primary endpoint of our study was the number of patients in whom at least 1 ASM had been withdrawn within 6 months after the initiation of regular ASM treatment.

The total number of children included in the study was 91 (53 in Group A, 38 in Group B) with a median age of 18.5 months and 31.9% being female. The most frequent causes of ASyS in our cohort included CNS infection (18.7%), hypoxic/ischemic injury (17.6%) and posterior reversible encephalopathy syndrome (13.2%). At least 1 ASM had been withdrawn in 21/47 (44.7%) patients of Group A compared to 25/34 (73.5%) patients of Group B (p = 0.009) at 6 months follow-up. In total, 17/47 patients (36.2%) of Group A and 21/34 patients (61.7%) of Group B were off all ASM at 6 months (p = 0.022). The median duration of follow-up was 18 months (IQR 9-26). Seizure recurrence after ASM withdrawal occurred only in 3 patients in our cohort. The vast majority of children (75/81, 92.6%) were seizure-free on their last follow-up. Regression analysis did not reveal any factors significantly associated with ≥ 1 ASM weaning at 6 months apart from the QI implementation.

The implementation of a weaning protocol through our QI project contributed to a reduction in the duration of ASM use among children with ASyS admitted to our hospital without considerable impact on seizure outcomes.