Early versus late antiepileptic drug withdrawal for people with epilepsy in remission

Sirven, Joseph I; Sperling, Michael R.; Wingerchuk, Dean M.

doi:10.1002/14651858.cd001902

Cited by 44 publications

(31 citation statements)

References 17 publications

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“…The optimum duration of treatment when seizure control has been achieved has not been established. 8 The presence of mental retardation and the presence of spikes on pre-withdrawal electroencephalogram increased the likelihood of a recurrence of seizures in this and other studies. Our case had normal intelligence and it is not our routine practice to perform withdrawal electroencephalograms in patients with primary generalised epilepsy.…”

Section: Commentarysupporting

confidence: 49%

The ethics of tiny trials

2002

Archives of Disease in Childhood

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For a year now, Archimedes has sought to assist practising clinicians to give the best care to patients and families; paediatricians need to integrate the highest quality scientific evidence with clinical expertise and the opinions of the family 1 by providing "evidence based" answers to common questions which are not at the forefront of research, but are at the core of practice. In doing this, we are adapting a format which has been successfully developed by Kevin Mackway-Jones and the group at the Emergency Medicine Journal-"BestBets".A word of warning. The topic summaries are not systematic reviews, though they are as exhaustive as a practising clinician can produce. They make no attempt to statistically aggregate the data, nor search the grey, unpublished literature. What Archimedes offers are practical, best evidence based answers to practical, clinical questions.The format of Archimedes may be familiar. A description of the clinical setting is followed by a structured clinical question. (These aid in focusing the mind, assisting searching, 2 and gaining answers.3 ) A brief report of the search used follows-this has been performed in a hierarchical way, to search for the best quality evidence to answer the question. 4 A table provides a summary of the evidence and key points of the critical appraisal. For further information on critical appraisal, and the measures of effect (such as number needed to treat, NNT) books by Sackett 5 and Moyer 6 may help. To pull the information together, a commentary is provided. But to make it all much more accessible, a box provides the clinical bottom lines.The electronic edition of this journal contains extra information on each of the published Archimedes topics. The papers summarised in tables are linked, by an interactive table, to more detailed appraisals of the studies. Updates to previously published topics will hopefully be available soon from the same site, published as "rapid responses" to the original article.

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Section: Commentarysupporting

confidence: 49%

The ethics of tiny trials

2002

Archives of Disease in Childhood

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“…A Cochrane systematic review, which included seven studies, evaluated the effect of early versus late (<2 years vs. >2 years of seizure freedom) AED withdrawal on seizure recurrence in children. [20] In 924 randomized children, the pooled RR for the seizure relapse in early withdrawal group was 1.32 (95% CI, 1.02-1.70). Similarly, in the randomized trial by Peters et al, AED withdrawal after 6 months of seizure freedom was associated with a relatively higher risk of seizure relapse, indicating that 6 months is probably too early to consider AED withdrawal.…”

Section: When and How To Withdraw Aedsmentioning

confidence: 99%

Stopping antiepileptic drugs in patients with epilepsy in remission: Why, When and How?

Rathore

Paterson

2014

Neurol India

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Making a decision to withdraw antiepileptic drugs (AEDs) in patients with epilepsy in remission requires a careful assessment of many patient and disease related factors and the associated risks and benefits. Although unnecessary continuation of AEDs exposes the patients to unwarranted side-effects, a premature withdrawal with subsequent seizure recurrence may be distressing for the patient who otherwise considers himself as cured. Although the final decision needs to be individualized, there are certain guidelines which can help us in making evidence based decision. In this article, we intend to review the current evidence on this subject with an aim of providing a framework of the best clinical practice in this field.

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“…Das Cochrane Review von Sirven et al [15] berück-sichtigt 7 prospektiv randomisierte Studien mit insgesamt 924 Kindern [4,8,11,17,18]. Drei der 7 Studien behandeln die gleiche Patientengruppe [3][4][5].…”

Section: Studien Zum Absetzen Der Ae Im Kindesalterunclassified

“…Sirven et al [15] fanden ein höheres Rückfallrisiko, wenn eine partielle Epilepsie vorlag (Rückfallrisiko 1,52 (95% CI 0.95 to 2.41)) oder wenn das EEG pathologisch war (Rückfallrisiko 1,67 (95% CI 0.93 to 3.00)). Andere Studien fanden folgende Risikofaktoren: weibliches Geschlecht [7], positive Familienanamnese für Epilepsie [14], Manifestationsalter über 10-12 Jahre [7,11,14], symptomatische Ätiolo-gie [14,17], neurologische Symptome [7], mentale Retardierung [14,16,17], atypische febrile Anfälle [14], fokale Anfälle ohne Rolando-Epilepsie [7,11,17], mehr als 5 Anfälle pro Jahr, Dauer der Anfälle über 15 Minuten oder wenn eine Anfallsfreiheit erst nach mehr als zwei Jahren Therapie erzielt werden konnte [17].…”

Section: Risikofaktoren Für Rückfallunclassified

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