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

Rathore, Chaturbhuj; Paterson, Ross W.

doi:10.4103/0028-3886.128224

Cited by 7 publications

(7 citation statements)

References 35 publications

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“…Over time, the cyst degenerates into a granuloma as the infection is cleared by the host; it then disappears or results in a calcified lesion that persists in the brain [3][4][5][6]. Calcified lesions are associated with clinical manifestations contrary to previous suggestions [7,8] and can be permanent foci of seizures and other neurological symptoms, although the pathogenic mechanisms are not well understood [9][10][11][12][13].…”

mentioning

confidence: 99%

Frequency and Determinant Factors for Calcification in Neurocysticercosis

Bustos

Arroyo

Gilman

et al. 2020

Clinical Infectious Diseases

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Background Neurocysticercosis (NCC) is a major cause of acquired epilepsy in most of the world. Larval cysts in the human brain eventually resolve and either disappear or leave a calcified scar that is associated with seizures. This study assessed the proportion of residual calcification in parenchymal NCC, and defined risk factors associated with calcification. Methods Data from 220 patients with parenchymal NCC from three randomized trials of antiparasitic treatment was assessed to determine what proportion of the cysts that resolved six months after antiparasitic treatment ended up in a residual calcification at one year. Also, we evaluated the risk factors associated with residual calcification. A multilevel Poisson regression model was used to estimate the risks of calcification. Results The overall proportion of calcification was 38% (188/497 cysts, from 147 patients). Predictors for calcification at the cyst level were cysts larger than 14 mm (RR 1.34; 95% C.I. 1.02-1.75), and cysts with edema at baseline (RR 1.39; 95% C.I. 1.05-1.85). At the patient level, having had more than 24 months with seizures (RR: 1.25, 95% C.I. 1.08-1.46), mild antibody response (RR: 1.14; 95% C.I. 1.002-1.27), increased dose albendazole regime (RR: 1.26; 95% C.I. 1.14-1.39), lower doses of concomitant dexamethasone (RR: 1.36; 95% C.I. 1.02-1.81), not receiving early antiparasitic re-treatment (RR: 1.45; 1.08-1.93), or complete cure (RR: 1.48; 1.29-1.71). Conclusions/Significance Approximately 38% of parenchymal cysts calcify after antiparasitic treatment. Some factors associated to calcification are modifiable and may be approached to decrease or avoid calcification, potentially decreasing the risk for seizure relapses.

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mentioning

confidence: 99%

Frequency and Determinant Factors for Calcification in Neurocysticercosis

Bustos

Arroyo

Gilman

et al. 2020

Clinical Infectious Diseases

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“…Det er få gode studier på dette feltet (19). Når det gjelder voksne, finnes det to der anfallsfrie pasienter ble randomisert til enten seponering eller fortsatt behandling.…”

Section: Få Gode Studierunclassified

Seponering av antiepileptika ved anfallsfrihet – når og hvordan?

Lossius¹,

Alfstad²,

Aaberg³

et al. 2017

Tidsskriftet

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“…However, this decision must be made carefully and is usually recommended after a minimum of 2 years of seizure freedom. The incidence of seizure recurrence following withdrawal lies between 20 and 50% – significantly higher than a treated population . If patients are carefully selected, this risk may be as low as 15%.…”

Section: Withdrawing Anti‐epilepticsmentioning

confidence: 99%

“…The incidence of seizure recurrence following withdrawal lies between 20 and 50%significantly higher than a treated population. 54 If patients are carefully selected, this risk may be as low as 15%. Risk factors for recurrence include a structural aetiology (for example, stroke or tumour), neurological deficits on physical examination and an abnormal EEG.…”

Section: Withdrawing Anti-epilepticsmentioning

confidence: 99%

Pharmacotherapy for epilepsy in the elderly

Bryson

Carney

2015

J Pharm Pract Res

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Epilepsy is the most common chronic neurological disorder worldwide and its incidence increases with age. A thorough clinical assessment, neuroimaging (ideally magnetic resonance imaging) and electroencephalography must be performed in all patients with epilepsy to determine the seizure type and the underlying aetiology. Epilepsy may be classified as either focal or generalised. In the elderly, focal epilepsy secondary to structural pathology (particularly stroke) is the most common cause. Careful cardiovascular risk assessment is therefore recommended in elderly patients with new seizures. In younger patients, genetic generalised epilepsies predominate. When a decision is made to initiate anti‐epileptic pharmacotherapy, the classification of epilepsy, its underlying cause and patient characteristics (particularly comorbidities and polypharmacy) determine the most suitable agent. In elderly patients, a single drug is often effective in controlling seizures. Although data in this population are limited, there is emerging evidence that newer anti‐epileptics such as levetiracetam and gabapentin are better tolerated. Some older agents such as phenytoin should be avoided due to the risks of toxicity and drug interactions. In this article, we outline the classification and causes of epilepsy and review the treatment options with an emphasis on the evidence base in the elderly. For the majority of elderly patients, anti‐epileptic pharmacotherapy will be required lifelong.

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

Cited by 7 publications

References 35 publications

Frequency and Determinant Factors for Calcification in Neurocysticercosis

Frequency and Determinant Factors for Calcification in Neurocysticercosis

Seponering av antiepileptika ved anfallsfrihet – når og hvordan?

Pharmacotherapy for epilepsy in the elderly

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