Discontinuation of antiepileptic drug treatment in controlled seizure patients

Uesugi, Hideji; Kojima, Tetsuhito; Miyasaka, Makoto; Ohtaka, Tadashi; Moriiwa, Motoi; Shimazono, Y

doi:10.1016/0896-6974(94)90027-2

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…From 2,588 articles identified, 61 articles were included in the meta‐analysis, of which 45 (7,082 patients) concerned medically treated patients (Emerson et al ., ; Holowach‐Thurston et al ., ; Shinnar et al ., ; Overweg et al ., ; Arts et al ., ; Callaghan et al ., ; Alvarez, ; Ehrhardt and Forsythe, ; Matricardi et al ., ; MRC, ; Gherpelli et al ., ; Galimberti et al ., ; Shinnar et al ., ; Tennison et al ., ; Uesugi et al ., ; Delgado et al ., ; Dooley et al ., ; Tinuper et al ., ; Braathen and Melander, ; Caviedes and Herranz, ; Marcus, ; Altunbasak et al ., ; Gebremariam et al ., ; Verrotti et al ., a; Verrotti et al ., b; Bouma et al ., ; Lamdhade and Taori, ; Specchio et al ., ; Cardoso et al ., ; Ohta et al ., ; Camfield and Camfield, ; Geerts et al ., ; Serra et al ., ; Sillanpaa and Schmidt, ; Lossius et al ., ; Olmez et al ., ; Ramos‐Lizana et al ., ; Vurucu et al ., ; Afshari and Moradian, ; Pavlovic et al ., ; Verrotti et al ., ; Su et al ., ; Yang et al ., ; Gafoor et al ., ; Li et al ., ), and 16 (2,441 patients) surgical cohorts (Murro et al ., ; Schiller et al ., ; Griffin et al ., ; Kim et al ., ; Berg et al ., ; Al‐Kaylani et al ., ; Sinclair et al ., ; Lachhwani et al ., ; Lee et al ., ; Kerling et al ., ; Park et al ., ; Rathore et al ., ; Boshuisen et al ., ; Menon et al ., ; Zeng et al ., ; Yardi et al ., …”

Section: Resultsmentioning

confidence: 99%

“…From 2,588 articles identified, 61 articles were included in the meta-analysis, of which 45 (7,082 patients) concerned medically treated patients (Emerson et al, 1981;Holowach-Thurston et al, 1982;Shinnar et al, 1985;Overweg et al, 1987;Arts et al, 1988;Callaghan et al, 1988;Alvarez, 1989;Ehrhardt and Forsythe, 1989;Matricardi et al, 1989;MRC, 1991;Gherpelli et al, 1992;Galimberti et al, 1993;Shinnar et al, 1994;Tennison et al, 1994;Uesugi et al, 1994;Delgado et al, 1996;Dooley et al, 1996;Tinuper et al, 1996;Braathen and Melander, 1997;Caviedes and Herranz, 1998;Marcus, 1998;Altunbasak et al, 1999;Gebremariam et al, 1999;Verrotti et al, 2000a;Verrotti et al, 2000b;Bouma et al, 2002;Lamdhade and Taori, 2002;Specchio et al, 2002;Cardoso et al, 2003;Ohta et al, 2004;Camfield and Camfield, 2005;Geerts et al, 2005;Serra et al, 2005;Sillanpaa and Schmidt, 2006;Lossius et al, 2008;Olmez et al, 2009 Afshari and Moradian, 2012;Pavlovic et al, 2012;Verrotti et al, 2012;Su et al, 2013;…”

Section: Resultsmentioning

confidence: 99%

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Antiepileptic drug withdrawal in medically and surgically treated patients: a meta‐analysis of seizure recurrence and systematic review of its predictors

Lamberink¹,

Otte

Geleijns³

et al. 2015

Epileptic Disorders

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Aim. Many seizure‐free patients consider withdrawal of antiepileptic drugs, both when seizure control is achieved by medication alone, or once they became seizure‐free following epilepsy surgery. The risk of recurrence is consequently of very important prognostic value. However, estimations of recurrence risks are outdated for both populations. In addition, although many publications have reported predictors of seizure relapse, no comprehensive overview of prognostic factors is available. Methods. A systematic review of the databases of PubMed and EMBASE was conducted, identifying articles on antiepileptic drug withdrawal in patient cohorts. Recurrence risk meta‐analyses were performed for both populations at one, two, three to four, and five or more years of follow‐up. Within the selected articles, studies presenting multivariable analysis of predictors were identified; all studied predictors were listed, as well as all significant independent predictors. The quality of separate analyses of predictors was assessed. Results. There was no significant difference of long‐term cumulative recurrence risk between surgical and medication‐only populations, with respectively 29% and 34% recurrences. In medication‐only treated patients, 25 factors have been reported as significant independent predictors; 12 have been reported in surgical cohorts. The quality of most analyses of predictors was low to moderate. No predictor was consistently found among all analyses, and for most predictors, study results were contradictory. Conclusion. No consistent set of predictors could be identified because a large number of variables have been identified in the literature, many studies reported contradicting results, study populations varied considerably, and the quality of the original studies was often low. Meta‐analysis of individual participant data is necessary, because it allows for (1) correction for differences in follow‐up duration between subjects and studies, (2) a study of interaction effects, (3) calculation of more accurate estimates valid across several populations, and (4) the assessment of each predictor's effect size.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Antiepileptic drug withdrawal in medically and surgically treated patients: a meta‐analysis of seizure recurrence and systematic review of its predictors

Lamberink¹,

Otte

Geleijns³

et al. 2015

Epileptic Disorders

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“…However, an abnormal EEG can serve as compelling evidence against drug withdrawal in a patient who remains unconvinced despite the presence of other negative risk factors. As indicated previously, serial EEG recordings may be useful for monitoring patients after drug withdrawal [47].…”

Section: The Role Of Eeg In Selecting Patients For Antiepileptic Drugmentioning

confidence: 89%

“…In one study, relapse occurred in 83% of patients in whom EEG worsened during dose reduction, compared with a relapse occurrence of 54% in patients in whom EEG remained unchanged [46]. Other studies have corroborated these observations [47]. Thus, the normalizing effect of medication seen in some patients may limit the usefulness of the EEG before drug withdrawal as an a priori tool in patient selection.…”

Section: The Role Of Eeg In Selecting Patients For Antiepileptic Drugmentioning

confidence: 96%

Discontinuation of AEDs: When and how?

Alsaadi¹,

Shakra²,

Turkawi³

2013

Health

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Once a patient has initiated an antiepileptic drug (AED) and achieved a sustained period of seizure freedom, the decision to discontinue AED should be balanced against continuation of AED therapy indefinitely. Studies show that the rate of seizure recurrence after AED withdrawal is about two to three times the rate in patients who continue AEDs. However, there are many benefits to AED withdrawal that should be evaluated on an individualized basis. AED discontinuation may be considered in patients whose seizures have been completely controlled for a prolonged period. There are several factors that would increase risk of recurrences which will be reviewed and discussed. As a consequence, the decision to withdraw or withhold treatment must be still individualized. In any patient, the decision to discontinue treatment should also take into effect the social aspects like driving license, job and leisure activities as well as emotional and personal factors and patients with adverse effects or drug interactions. Patients will ultimately have to decide themselves whether they wish to discontinue drug treatment.

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