Carbamazepine withdrawal

Abstract

We prospectively investigated the effects of rate of carbamazepine (CBZ) withdrawal and CBZ level on seizure type and frequency in 12 epilepsy patients withdrawn completely from antiepileptic drugs prior to entering an investigational monotherapy trial. Patients withdrawn from CBZ rapidly (over 4 days) experienced significantly more generalized tonic-clonic seizures (GTCSs) and GTCS clusters than did those withdrawn slowly (over 10 days). Complex partial seizure (CPS) frequency did not differ between the two groups. CPSs preceded GTCSs, with GTCSs occurring in the majority of patients after CBZ had been discontinued, at subtherapeutic or absent CBZ levels. Two of six patients who had been tapered rapidly and all six patients who had been tapered slowly were able to enter the investigational monotherapy trial.

Antiepileptic Drug Withdrawal in Patients with Temporal Lobe Epilepsy Undergoing Presurgical Video‐EEG Monitoring

“…With a more strict definition of three or more CPSs within 24 h than that of Mark et al (3), seizure clusters occurred in 48.3% of our patients. Whether oral, rectal, or intravenous infusion of other AEDs like DZP or PHT is better in this situation, as previously suggested (13)(14)(15)(16)(17)(18)(19)(20), deserves further study. Intravenous injection of LZP probably played a role in preventing status epilepticus, and might prolong the stay in the EMU.…”

The impact of nonadherence to antiseizure drugs on seizure outcomes in an animal model of epilepsy

“…Finally, we examined whether a drug holiday would lead to less efficacy to the same drug when resumed after the drug holiday; that is, does increased seizure frequency and seizure burden contribute to poorer seizure control. Clinical observations have shown that rapid CBZ withdrawal leads to an increased seizure burden Thus it is not surprising that an abrupt worsening of seizure control was recorded after animals stabilized on 100% CBZ were abruptly switched to the placebo food (0%). We aimed to test the hypothesis that the occurrence of seizures is associated with intractability and drug resistance, that is, people whose seizures are not controlled for extended periods can find their seizures refractory to treatment upon reinitiating their therapy; in other words there is a price to pay for losing seizure control and drug holidays that result in intermittent seizures can result in drug resistance.…”

Anticonvulsant Effects of Carbamazepine on Spontaneous Seizures in Rats with Kainate‐induced Epilepsy: Comparison of Intraperitoneal Injections with Drug‐in‐food Protocols

“…Additional studies are needed to determine if the prolonged pharmacodynamic effects are due to the pharmacokinetics of CBZ after this form of oral administration or to some other mechanism. Because the apparent rebound effect occurred after a single administration of CBZ, it seems unlikely that it reflects the classical “rebound” that has been observed when patients are withdrawn from CBZ after it has been administered for prolonged periods (Duncan et al, 1990; Malow et al, 1993; Schmidt and Loscher, 2005), but additional experiments on this phenomenon are warranted.…”