The Challenge of Long Term Antiepileptic Treatment in the Post Transplant Population (P2.052)

Background: Seizures are a common neurological complication in transplant recipients. Triggers are multiple and can occur at any time after transplantation. Epilepsy in patients with acute symptomatic seizures in the first week after transplantation is low as we have seen in a previous study by our group. Since this is a complex population with potential clinical complications that delay their hospital discharge, we decided to consider symptomatic seizures all that occurred during the first month after transplantation (SSTx30), to assess the time of suspension of the anti-epileptic drug (AED) and the outcome of patients in order to improve the therapeutic strategy. Methods: Retrospective analysis of medical records of transplant recipients who have had a neurological event from April 2006 to July 2014 looking for SSTx30. We evaluated the clinical characteristics and their clinical course over a one-year period. Results: We found 249 neurological events, 101 seizures, 36 SSTX30. Eighteen patients were excluded (5 with known epilepsy, 8 deaths and 5 lost data). Eighteen SSTX30 followed for one year. Three patients without AED at discharge, none of them had seizures (all with calcineurin inhibitors). Of the 15 with AED at discharge, 10 remained with AED beyond one year (AEDy), 2 with AED without seizures in plan to discontinue treatment, 4 had seizures within that period (1 non-convulsive status epilepticus). Six AEDy without recurrent seizures (all with abnormal neuroimage and 3 with pathologic EEG). Five without AED had no new seizures. Conclusions: The majority of transplant recipients experiencing SSTx30 do not develop epilepsy. The suspension of AED before discharge can be a suitable strategy. The literature supporting this consensus is poor and our hypothesis though tempting, is far from sustained. Further work is needed with large number of patients to corroborate our hypothesis. Disclosure: Dr. Nadile has nothing to disclose. Dr. Gonzalez Toledo has nothing to disclose. Dr. Analia Calle has received personal compensation for activities with UCB Pharma as a scientific advisory board member. Dr. Tamargo has nothing to disclose. Dr. Thomson has nothing to disclose. Dr. Thomson has nothing to disclose. Dr. Molina Melendres has nothing to disclose. Dr. Pagani Cassara has nothing to disclose. Dr. Fontela has received personal compensation for activities with Quintiles as an employee. Dr. Couto has nothing to disclose.