With the ever-present risk of seizure looming, decision-making can be difficult for patients with epilepsy. Balancing risks and rewards can be tricky in all aspects of their lives. So it’s natural that you want to remove any uncertainty about treatment that you can, helping them maintain as much control over this aspect of their lives as possible. As their neurologist, your knowledge is a tool that can help them navigate uncertainty.
But what happens when their normally stable situation becomes less so and you aren’t there? Perhaps your patient is in college in another city, or even just on vacation. This is where the new guidelines the American Epilepsy Society submitted to Choosing Wisely can really pay off. With so many options for treatment, with varying levels of evidence behind them, it is an invaluable tool. When patients find themselves needing to make treatment decisions without their trusted doctor, Choosing Wisely can offer much needed clarity.
Choosing Wisely solicits medical specialty societies, like the American Epilepsy Society, to submit lists of medical interventions whose necessity might be questionable. As the American Academy of Neurology explains it:
The Choosing Wisely® campaign is designed to help consumers and physicians engage in conversations about the overuse of particular tests, procedures, and treatments, and to help patients make smart and effective care choices. Choosing Wisely promotes conversations between clinicians and patients by helping patients choose care that is supported by evidence and truly necessary.”
In this spirit, the American Epilepsy Society submitted its list of five things physicians and patients should question. The list includes:
- Avoid routine testing for anti-epileptic drug levels in people with epilepsy.
- Do not treat females of childbearing potential with Valproate if other effective treatments are available.
- Do not routinely order electroencephalogram (EEG) as part of initial syncope work-up.
- Do not prescribe long-term treatment with antiepileptic drugs after withdrawal seizures.
- Do not routinely perform brain imaging after acute seizure in patients with established epilepsy.
An explanation for each of these points is provided on the Choosing Wisely website, along with references to peer-reviewed research to support it.
Using these recommendations as a starting point for discussion with patients can help build the physician-patient relationship and improve the shared decision-making process. It can also help patients better grasp the value of evidence in pursuing treatment and testing.
Patients with epilepsy who understand these recommendations can also use them to advocate for themselves if they ever require care outside of their established neurologist-patient relationship.
Understanding these recommendations won’t entirely remove the uncertainty these patients must face, but it will allow them to maintain some control and confidence as they weigh the pros and cons of treatment options.
The Choosing Wisely initiative offers many resources to help clinicians incorporate Choosing Wisely into their practices.
You can learn more about neurology-focused Choosing Wisely recommendations from the analysis in the journal Neurology Clinical Practice.