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

Lookup NU author(s): Guillermo BesneORCiD, Nathan Evans, Dr Mariella Panagiotopoulou, Billy Smith, Professor Peter TaylorORCiD, Dr Christopher Thornton, Professor Yujiang WangORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© The Author(s) 2025. Published by Oxford University Press on behalf of the Guarantors of Brain. Anti-seizure medications 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 h of intracranial EEG recordings in 32 subjects during long-term monitoring, of which 22 underwent concurrent anti-seizure medication tapering. We estimated anti-seizure medication plasma levels based on known pharmaco-kinetics of all the major anti-seizure medication types. We found an overall decrease in the power of delta band (δ) 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 δ power decrease. This dose-dependent effect was evident across all recorded cortical regions during daytime; but not in subcortical 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 δ band power during anti-seizure medication tapering agrees with previous literature. Our observed dose-dependent effect indicates that monitoring anti-seizure medication levels in cortical regions may be feasible for applications such as medication reminder systems, or closed-loop anti-seizure medication delivery systems. Anti-seizure medications are also used in other neurological and psychiatric conditions, making our findings relevant to a general neuroscience and neurology audience.

Publication metadata

Author(s): Besne GM, Evans N, Panagiotopoulou M, Smith B, Chowdhury FA, Diehl B, Duncan JS, McEvoy AW, Miserocchi A, de Tisi J, Walker MC, Taylor PN, Thornton C, Wang Y

Publication type: Article

Publication status: Published

Journal: Brain Communications

Year: 2025

Volume: 7

Issue: 1

Online publication date: 25/02/2025

Acceptance date: 19/02/2025

Date deposited: 17/03/2025

ISSN (electronic): 2632-1297

Publisher: Oxford University Press

URL: https://doi.org/10.1093/braincomms/fcaf020

DOI: 10.1093/braincomms/fcaf020

Data Access Statement: Anonymised EEG band power data and ASM intake schedule, along with analysis code will be available on Github: https://github.com/cnnp-lab/2024_ASM_EEG.

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