Treatment Experiences With Anti-Seizure Medications (ASMs): Patient and Clinician Perspectives on Titration Burden, Quality of Life, and No-Titration Options

Document Type

Conference Proceeding

Publication Date

6-9-2026

Publication Title

Neurology

Abstract

Objective: To compare the perspectives of patients with focal seizures (FS) and healthcare providers (HCPs) on anti-seizure medication (ASM) experiences during titration. Background: ASM titration is an understudied component of FS management. Few studies have characterized real-world titration experiences from both patient and HCP perspectives. Design/Methods: An IRB-approved web survey of patients with FS (N = 48; January 2025) evaluated patient titration experiences. Seven US HCPs (epileptologists with a mean 20 years in practice) completed 30-minute interviews about ASM titration and subsequently participated in a roundtable discussion (April 2025). Results: Patients self-reported barriers during titration, including difficulty following schedules due to frequent dose changes (42%) and disruptions to daily life from clinic visits and phone calls (42%). All HCPs (100%) identified drug–drug interactions (DDIs) as a titration challenge and reported difficulty managing cross-titration when switching ASMs to mitigate interaction risks. Among patients, 85% reported feeling nervous during titration at least “some of the time,” whereas fewer than 15% of patients reported feeling “calm and peaceful” or “happy” “most or all of the time” during titration. All HCPs (100%) indicated that the titration process can be associated with stress for patients, providers, or both. When considering an ASM without titration, 84% of patients agreed it would be easier to remember how to take the medication properly, and 77% agreed they would feel less anxious. The majority of HCPs (86%) agreed that minimal- or no-titration ASMs can lessen the burden for patients and providers. Conclusions: Patients and HCPs agreed that ASM titration can be burdensome and avoiding titration may offer benefits. Patients reported difficulty managing medication schedules and a negative impact on daily life during titration, while HCPs emphasized challenges with managing its complexity (e.g., cross-titration). These findings underscore the titration burden, with an opportunity to further integrate the patient voice in treatment decision-making.

Volume

106

Issue

11 Suppl 1

First Page

1907

Comments

American Academy of Neurology Annual Meeting, April 18-22, 2026, Chicago, IL

Last Page

1907

DOI

10.1212/WNL.0000000000215483

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