Influence of the ‘Lost Time’ on the Outcome of Epilepsy

Oller-Daurella, L; Oller, L

doi:10.1159/000116672

Cited by 13 publications

(6 citation statements)

References 2 publications

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“…Based on a meta-analysis of the literature, 1 the risk of relapse after drug withdrawal was 25% at 1 year and 29% at 2 years. Several factors have been implicated in the risk of relapse, including age at onset of seizures, 2-7 age at treatment withdrawal, 5 8-11 family history of epilepsy, 5 12-14 recognised aetiology of epilepsy or abnormal neurological or psychiatric findings, 5 8 9 13-18 EEG abnormalities, 7 10 14- 16 18-22 number of seizures preceding remission, 2 8 9 11 13 15-17 23 24 and duration of seizure free period on treatment. 11 12 16 25 The risk of seizure relapse attributable to drug discontinuation is less well defined.…”

mentioning

confidence: 99%

Discontinuing antiepileptic drugs in patients who are seizure free on monotherapy

Specchio¹,

Tramacere

Neve

et al. 2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

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Objectives: To assess the recurrence rate of epilepsy attributable to discontinuation of treatment in seizure free patients and to identify the risk factors for recurrence. Methods: 330 patients referred to an epilepsy centre who were seizure free for at least 2 years while on stable monotherapy were the study population. Discontinuation of antiepileptic drugs (AEDs) was proposed to all eligible patients or to their carers after discussion of the risks and benefits. Depending on whether they accepted or refused treatment withdrawal, the patients were stratified into two cohorts and followed up until seizure relapse or 31 March 1999, whichever came first. For each patient, records were taken of the main demographic and clinical variables. Results: The sample comprised 225 patients who entered the discontinuation programme and 105 who decided to continue treatment. Twenty nine patients (28%) continuing treatment had a relapse, compared with 113 (50%) of those entering the withdrawal programme. For patients continuing treatment, the probability of remission was 95% at 6 months, 91% at 12 months, 82% at 24 months, 80% at 36 months, and 68% at 60 months. The corresponding values for patients discontinuing treatment were 88%, 74%, 57%, 51%, and 48%. After adjusting for the principal prognostic factors, in patients discontinuing AEDs the risk of seizure relapse was 2.9 times that of patients continuing treatment. A relation was also found between relapse and duration of active disease, number of years of remission while on treatment, and abnormal psychiatric findings. Conclusions: Seizure free referral patients on stable monotherapy who elect to withdraw drug treatment are at higher risk of seizure relapse compared with patients continuing treatment. Severity of disease and seizure free period are significant prognostic factors. I n patients with epilepsy who are seizure free for a period while on antiepileptic drugs (AEDs), the question arises whether treatment can be withdrawn. The decision to discontinue AEDs is based on the chance of remaining seizure free after drug withdrawal, the presence of factors predictive of a higher risk of seizure recurrence, and the medical and social consequences of the withdrawal compared with continuation of treatment. The risk of seizure relapse after withdrawal of AEDs has been estimated at from 10% to 70% depending on the method and design of the studies. Based on a meta-analysis of the literature, 1 the risk of relapse after drug withdrawal was 25% at 1 year and 29% at 2 years. Several factors have been implicated in the risk of relapse, including age at onset of seizures, 2-7 age at treatment withdrawal, The risk of seizure relapse attributable to drug discontinuation is less well defined. The only study comparing continued antiepileptic treatment and drug withdrawal showed that 78% of patients continuing and 59% of those stopping AEDs remained seizure free two years after randomisation. 11 In that study the patients were enrolled regardless of whether they were taking one or mor...

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mentioning

confidence: 99%

Discontinuing antiepileptic drugs in patients who are seizure free on monotherapy

Specchio¹,

Tramacere

Neve

et al. 2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

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“…Alternatively, Lee et al [2] have suggested that the late onset of seizures in card game-induced reflex epilepsy reflects a phenotypic difference in the clinical spectrum of idiopathic generalized epilepsy. They insisted that card game-induced reflex epilepsy might be another type of adult-onset idiopathic generalized epilepsy, which was supported usually by normal interictal EEG findings in both adult-onset idiopathic generalized epilepsy and card game-induced reflex epilepsy [2,31] . Goossens et al [27] also reported 15 patients with card game-induced reflex epilepsy who mostly had generalized spike, spike-wave, or poly-spikewave discharges in EEG and seizures consisted of myoclonus, absences, and generalized convulsions, and they suggested that the clinical and EEG findings supported the diagnosis of primary generalized epilepsy.…”

Section: Discussionmentioning

confidence: 97%

The Pivotal Role of the Parieto-Occipital Lobe in Card Game-Induced Reflex Epilepsy: A Voxel-Based Morphometry Study

Park

Kim²,

Lee³

2016

Eur Neurol

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Background: The pathogenesis of card game-induced reflex epilepsy has not been determined so far. The aim of this study was to evaluate structural abnormalities using voxel-based morphometry (VBM) analysis, which may give some clue about the pathogenesis in card game-induced reflex epilepsy. Methods: The 3 subjects were diagnosed with card game-induced reflex epilepsy. Evaluation involved a structured interview to obtain clinical information and brain MRI. In VBM analysis, Statistical Parametric Mapping 8 running on the MATLAB platform was employed to analyze the structural differences between patients with card game-induced reflex epilepsy and age- and sex-matched control subjects. Results: The results of VBM analysis revealed that patients with card game-induced reflex epilepsy had significantly increased gray matter volume in the right occipital and parietal lobe. However, there were no structures with decreased gray matter volume in patients with card game-induced reflex epilepsy compared with control subjects. In addition, we found that the patients with card game-induced reflex epilepsy had onset of seizures in adulthood rather than in adolescence, and all of the patients were men. Conclusions: The parieto-occipital lobes might be partially involved in the neuronal network responsible for card game-induced reflex epilepsy.

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“…There is no consensus on the mode of withdrawal. Tapering of AEDs ranges from rapid withdrawal to slow withdrawal spread over a period of two years (Bouma 1987;Duncan 1987;Oller-Daurella 1975;Overweg 1981;. In other studies, the tapering period has come down to three to six months, reflecting a di erent clinical approach (Arts 1988;Callaghan 1988;Emerson 1981;MRC 1991;Tennison 1994), but as yet there is no consensus in this tapering regimen.…”

Section: Why It Is Important To Do This Reviewmentioning

confidence: 99%