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April 6, 2020

Deprescribing in Epilepsy: Do No Harm

Author Affiliations
  • 1Department of Neurology, University of Michigan, Ann Arbor
  • 2Brain Center Rudolf Magnus, Department of Child Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
JAMA Neurol. Published online April 6, 2020. doi:10.1001/jamaneurol.2020.0473

A simple search of PubMed reveals striking insight. Querying the term prescribing yields 44 379 hits. In contrast, deprescribing yields only 672. Completing this exercise for a neurological condition such as epilepsy prescribing and epilepsy deprescribing yields similar results: 408 hits for the former and 3 for the latter. While this search is clearly overly simplistic, it illustrates a crucial point: attention is tremendously imbalanced.

What is the result? Half of US adults older than 65 years take 5 or more medications.1 It is no surprise that one survey found 67% of patients wanted to reduce their number of daily pills and 92% would be willing to stop a medication if their physician said it was possible.1 The emerging field of deprescribing—the systematic process of discontinuing drugs where harms outweigh benefits in the context of an individual patient’s values—seeks to rescue patients and clinicians alike.

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