Risk factors for seizure reoccurrence after withdrawal from antiepileptic drugs in individuals who have been seizure-free for over 2 years

Tang, Xiaolin; Yu, Peimin; Ding, Ding; Ge, Yan; Shi, Yunbo; Wang, Ping; Zhu, Guangfa; Hong, Zhen

doi:10.1371/journal.pone.0181710

Cited by 16 publications

(15 citation statements)

References 23 publications

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“…For some patients with drug-resistant epilepsy whose seizures do not respond to AEDs, surgical treatment may eliminate seizures [7,8]. Both doctors and patients are concerned about safe withdrawal from AEDs and further improvement in the quality of life in patients who are seizure-free after medical or surgical treatment [9][10][11], because long-term use of AEDs exerts adverse effects on the central nervous system and many other side effects, including sedation, drowsiness, dizziness, ataxia, cognitive dysfunction, pancytopenia, liver and kidney dysfunction, weight changes, fertility issues, and bone problems, as well as mental and economic burdens [12][13][14][15][16][17].…”

Section: Introductionmentioning

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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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: Introductionmentioning

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 sample size was calculated according to previous data of patients with ASMs withdrawal (14,(22)(23)(24). In real-world clinical practice, the proportion of patients in the two groups was not evenly distributed at the time of ASM withdrawal.…”

Section: Sample Size Calculationmentioning

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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“…Daha önce de belirtildiği gibi benzer çalışmalarda elde edilen karşıt sonuçlar çalışmaya alınan hasta gruplarıyla ilişkili olup, Tang ve ark. 'nın (9) çalışmasında erişkin yaş grubunun da bulunması çalışmamızla uyumsuz sonuçlarını açıklayabilir.…”

Section: İstatistiksel Analizunclassified

İdiyopatik Epilepsi Tanılı Çocuk Hastalarda Antiepileptik Tedavi Kesimi Sonrası Nöbet Tekrarı ile İlişkili Risk Faktörleri

Taktak¹,

Özkan²,

Zorlu³

2021

Turkish Journal of Pediatric Disease

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Bu çalışmanın amacı idiyopatik epilepsi tanılı çocuklarda antiepileptik tedavi kesimi sonrası nöbet tekrarına etki eden risk faktörlerini değerlendirmektir. Gereç ve Yöntemler: En az 24 ay antiepileptik tedavi alan, kraniyal manyetik rezonans görüntüleme ve elektroensefalografi sonuçları normal olan hastaların ilaç tedavisi 4-6 aylık süreçte azaltılarak kesilmiştir. Tedavi kesimi sonrası nöbeti tekrarlayan 72 hasta relaps grubunu, nöbeti tekrar etmeyen 82 hasta ise remisyon grubunu oluşturmuştur. Bulgular: Hastaların tanı yaşı ve tedavi başlanması sonrasında nöbet kontrol sürelerinin relaps üzerine etki eden risk faktörleri olduğu görülmüştür. Relaps grubundaki hastaların %95.9'unda nöbet tekrarının ilk 2 yıl içerisinde geliştiği belirlenmiştir. Sonuç: Tedavi başlanmasından sonra nöbet kontrol süresi 3 ay ve üzerinde olan hastalarda ilaç kesim sonrası tekrarlama riski daha yüksektir. Ayrıca epilepsi tanı yaşı 12 ve üzerinde olan hastalarda da tekrarlama riskinin yüksek olduğu görülmüştür. Bununla birlikte antiepileptik tedavisi kesilen tüm hastalarda 2 yıl yakın takip önermekteyiz.

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Risk factors for seizure reoccurrence after withdrawal from antiepileptic drugs in individuals who have been seizure-free for over 2 years

Cited by 16 publications

References 23 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

İdiyopatik Epilepsi Tanılı Çocuk Hastalarda Antiepileptik Tedavi Kesimi Sonrası Nöbet Tekrarı ile İlişkili Risk Faktörleri

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