Can electroencephalograms provide guidance for the withdrawal of antiepileptic drugs: A meta-analysis

Tang, Liwei; Xiao, Zheng

doi:10.1016/j.clinph.2016.11.024

Cited by 26 publications

(16 citation statements)

References 27 publications

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“…Electroencephalogram, particularly prolonged EEG monitoring, is often used to predict the risk of AED withdrawal [75][76][77][78]. Several retrospective studies, prospective studies, and meta-analyses have analyzed EEG abnormalities, particularly the effects of interictal epileptiform discharges (IEDs) on postdwithdrawal relapse, with controversial conclusions [79][80][81][82][83][84][85].…”

Section: Eegmentioning

confidence: 99%

“…In general, the recurrence rate is higher in patients with IEDs before withdrawal [75]. A large meta-analysis of 2349 patients with epilepsy conducted in 2017 showed that an abnormal EEG before withdrawal, particularly paroxysmal, slowing, spike and wave activities, are a red flag for recurrence [76]. Rathore et al [77] followed 262 patients with temporal lobe epilepsy and observed a three times higher recurrence risk after withdrawal in patients with IEDs within a year of epilepsy surgery than in patients with a normal EEG.…”

Section: Eeg Before Withdrawalmentioning

confidence: 99%

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Prediction of the recurrence risk in patients with epilepsy after the withdrawal of antiepileptic drugs

Yang

Zhang

Long

et al. 2020

Epilepsy & Behavior

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Many seizure-free patients who consider withdrawing from antiepileptic drugs (AEDs) hope to discontinue treatment to avoid adverse effects. However, withdrawal has certain risks that are difficult to predict. In this study, we performed a literature review, summarized the causes of significant variability in the risk of postwithdrawal recurrent seizures, and reviewed study data on the age at onset, cause, types of seizures, epilepsy syndrome, magnetic resonance imaging (MRI) abnormalities, epilepsy surgery, and withdrawal outcomes of patients with epilepsy. Many factors are associated with recurrent seizures after AED withdrawal. For patients who are seizure-free after treatment, the role of an electroencephalogram (EEG) alone in ensuring safe withdrawal is limited. A series of prediction models for the postwithdrawal recurrence risk have incorporated various potentially important factors in a comprehensive analysis. We focused on the populations of studies investigating five risk prediction models and analyzed the predictive variables and recommended applications of each model, aiming to provide a reference for personalized withdrawal for patients with epilepsy in clinical practice.

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Section: Eegmentioning

confidence: 99%

Section: Eeg Before Withdrawalmentioning

confidence: 99%

Prediction of the recurrence risk in patients with epilepsy after the withdrawal of antiepileptic drugs

Yang

Zhang

Long

et al. 2020

Epilepsy & Behavior

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“…The correlation between EEGs and epilepsy recurrence is disputable. Previous evidence has demonstrated that an abnormal EEG before ASM withdrawal is a predictor of the relapse ( 7 , 38 ). In this study, we did not observe significant differences in the EEG results collected before treatment and before withdrawal between the monotherapy and polytherapy groups, probably due to the relatively small sample size and the fact that EEG was only measured for 2 h. Yao et al ( 39 ) reported that abnormal EEG during withdrawal was a risk factor for recurrence.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Long-Term Outcomes of Monotherapy and Polytherapy in Seizure-Free Patients With Epilepsy Following Antiseizure Medication Withdrawal

Wang

et al. 2021

Front. Neurol.

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Objective: The objectives of this study were to compare the risk and timing of seizure relapse in seizure-free patients with epilepsy following the withdrawal of monotherapy or polytherapy and to identify relevant influencing factors.Methods: Patients who had achieved at least a 2-year seizure remission and started the withdrawal of antiseizure medication (ASM) were enrolled in this study. All patients were followed for at least 3 years or until seizure relapse. According to the number of ASMs at the time of withdrawalwas about twice than that, patients were divided into two groups: monotherapy group and polytherapy group. The Cox proportional hazards model was used to compare the recurrence risk of the two groups. Univariate analysis and multiple logistic regression analysis were used to analyze potential confounding variables between patients treated with monotherapy and polytherapy.Results: A total of 188 patients (119 males and 69 females) were included. The average prescribed daily dose of most ASMs at the time of withdrawal was moderate or low (30–50% defined daily dose). The recurrence of most patients (89.2%) occurred within the first 3 years after withdrawal. The recurrence risk in patients treated with polytherapy at the time of withdrawal was about twice than that of the monotherapy group [p = 0.001, hazard ratio (HR) = 2.152, 95% confidence interval (CI) = 1.350–3.428]. Multivariate analysis showed that patients treated with polytherapy were significantly older at seizure onset [p = 0.024, odd ratio (OR) = 1.027, 95% CI = 1.004–1.052] and had a significantly longer duration of epilepsy before treatment (p = 0.004, OR = 1.009, 95% CI = 1.003–1.015) compared to patients in the monotherapy group. In addition, a history of perinatal injury was found to be an independent risk factor of seizure relapse in patients with ASM withdrawal.Conclusion: The average prescribed daily dose of most ASMs at the time of withdrawal was moderate or low. Patients who received polytherapy at the time of withdrawal, particularly those with later seizure onset age and longer epilepsy duration before treatment, had a higher recurrence risk after ASMs withdrawal compared to patients treated with monotherapy.

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“…d. Abnormal interictal encephalogram (EEG). The presence of an abnormal EEG before AED withdrawal or during the 1 st year after AED withdrawal indicates greater risk of recurrence 1,22,23 . e. Focal and generalized symptomatic tonic-clonic epilepsies have a greater risk of recurrence 9,20 .…”

Section: Question 3 What Are the Risk Factors For Recurrence Of Epileptic Seizures In Adult Patients After Suspending Antiepileptic?mentioning

confidence: 99%

“…Although there are no examinations that are completely reliable to predict the recurrence of seizures, many studies have demonstrated that abnormalities in the EEG, before or after AED withdrawal, increase the risk of recurrence 15,16 . A recent meta-analysis reported that the presence of EEG paroxysms before AED withdrawal predicts a high percentage of recurrences (Table 1) 23 .…”

Section: Question 5 What Is the Usefulness Of An Eeg To Decide On Aed Withdrawal?mentioning

confidence: 99%

Clinical guide: discontinuing chronic antiepileptic drug treatment

Loy-Gerala¹,

Ibarra-Bravo²,

Márquez-Estudillo³

et al. 2021

RMN

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The decision to continue or withdraw the antiepileptic drugs (AEDs) should be taken jointly by the patient, family and/or caregivers, and the specialist physician, after extensive information and discussion about the risks and benefits of withdrawing the AED. The patient and family members must understand that there is a risk of the recurrence of seizures with and without AED. The type of epilepsy, the prognosis, and the patient's lifestyle should be taken into account. Withdrawal should be carried out under the supervision of a specialist (clinical neurologist) and will be considered when the patient has been seizure free for at least 2 years. The treatment must be withdrawn gradually for a period of at least 2-3 months and the antiepileptics must be removed one by one. Withdrawal of benzodiazepines and barbiturates should be slower, in 6 months or more. An agreement must be made that in the event of a seizure relapse, the patient must return to taking the last dose before the dose in which the relapse was presented and request assessment by clinical neurologist.

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Can electroencephalograms provide guidance for the withdrawal of antiepileptic drugs: A meta-analysis

Cited by 26 publications

References 27 publications

Prediction of the recurrence risk in patients with epilepsy after the withdrawal of antiepileptic drugs

Prediction of the recurrence risk in patients with epilepsy after the withdrawal of antiepileptic drugs

Comparison of Long-Term Outcomes of Monotherapy and Polytherapy in Seizure-Free Patients With Epilepsy Following Antiseizure Medication Withdrawal

Clinical guide: discontinuing chronic antiepileptic drug treatment

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