Anti-seizure medication tapering correlates with daytime delta band power reduction in the cortex

Guillermo M. Besne; Nathan Evans; Mariella Panagiotopoulou; Billy Smith; Fahmida A Chowdhury; Beate Diehl; John S Duncan; Andrew W McEvoy; Anna Miserocchi; Jane de Tisi; Mathew Walker; Peter N. Taylor; Chris Thornton; Yujiang Wang

arXiv · 2405.01385

Anti-seizure medication tapering correlates with daytime delta band power reduction in the cortex

Guillermo M. Besne·Nathan Evans·Mariella Panagiotopoulou·Billy Smith·Fahmida A Chowdhury·Beate Diehl·John S Duncan·Andrew W McEvoy·Anna Miserocchi·Jane de Tisi·Mathew Walker·Peter N. Taylor·Chris Thornton·Yujiang Wang

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Abstract

Anti-seizure medications (ASMs) are the primary treatment for epilepsy, yet medication tapering effects have not been investigated in a dose, region, and time-dependent manner, despite their potential impact on research and clinical practice. We examined over 3000 hours of intracranial EEG recordings in 32 subjects during long-term monitoring, of which 22 underwent concurrent ASM tapering. We estimated ASM plasma levels based on known pharmaco-kinetics of all the major ASM types. We found an overall decrease in the power of delta band activity around the period of maximum medication withdrawal in most (80%) subjects, independent of their epilepsy type or medication combination. The degree of withdrawal correlated positively with the magnitude of delta power decrease. This dose-dependent effect was evident across all recorded cortical regions during daytime; but not in sub-cortical regions, or during night time. We found no evidence of a differential effect in seizure onset, spiking, or pathological brain regions. The finding of decreased delta band power during ASM tapering agrees with previous literature. Our observed dose-dependent effect indicates that monitoring ASM levels in cortical regions may be feasible for applications such as medication reminder systems, or closed-loop ASM delivery systems. ASMs are also used in other neurological and psychiatric conditions, making our findings relevant to a general neuroscience and neurology audience.

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Guillermo M. Besne, Nathan Evans, Mariella Panagiotopoulou, Billy Smith, Fahmida A Chowdhury, Beate Diehl, John S Duncan, Andrew W McEvoy, Anna Miserocchi, Jane de Tisi, Mathew Walker, Peter N. Taylor, Chris Thornton, Yujiang Wang. 2024-05-02. Anti-seizure medication tapering correlates with daytime delta band power reduction in the cortex. https://arxiv.org/abs/2405.01385

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