Discontinuing antiepileptic drugs in long-standing idiopathic generalised epilepsy

Vorderwülbecke, Bernd J.; Kirschbaum, Andrea; Merkle, Hannah; Senf, Philine; Holtkamp, Martin

doi:10.1007/s00415-019-09457-z

Cited by 17 publications

(7 citation statements)

References 16 publications

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“…Previous studies almost exclusively investigated the factors associated with seizure recurrence after having discontinued ASMs. [31][32][33] Consistent with our clinical practice observations, we found that relapse incidence was strongly influenced by the duration of previous remission, as evidenced by the almost doubled relapse rate among patients with a previous 2-year remission compared to those with a previous 4-year remission. Interestingly, we also observed that longer intervals from onset to 4-year remission were associated with an increased risk of subsequent GTCS relapse, further supporting the importance of early medication response as a long-term prognostic indicator in JME patients.…”

Section: Discussionsupporting

confidence: 89%

“…In the present study, we also investigated seizure relapse over a long‐term follow‐up, focusing on spontaneous relapses not related to medication withdrawal trials. Previous studies almost exclusively investigated the factors associated with seizure recurrence after having discontinued ASMs 31–33 . Consistent with our clinical practice observations, we found that relapse incidence was strongly influenced by the duration of previous remission, as evidenced by the almost doubled relapse rate among patients with a previous 2‐year remission compared to those with a previous 4‐year remission.…”

Section: Discussionsupporting

confidence: 88%

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Seizure outcome trajectories in a well‐defined cohort of newly diagnosed juvenile myoclonic epilepsy patients

Irelli

Morano

Orlando

et al. 2021

Acta Neuro Scandinavica

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 88%

Seizure outcome trajectories in a well‐defined cohort of newly diagnosed juvenile myoclonic epilepsy patients

Irelli

Morano

Orlando

et al. 2021

Acta Neuro Scandinavica

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“…A recent Norwegian report showed that no follow‐up does not necessarily mean no seizures . Conversely, successful JME treatment discontinuation has also been reported . It is assumed that persons who are not seeking or are not referred to specialized medical help and have no seizures in public (most often resulting in admission to the emergency room) are not affected by severe drug‐resistant seizures and are probably free from generalized tonic–clonic seizures.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and outcome of idiopathic generalized epilepsy in adults

Gesche

Christensen

Hjalgrim³

et al. 2020

Euro J of Neurology

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Background and purpose Drug‐resistant idiopathic generalized epilepsy (IGE) remains challenging despite a favourable overall prognosis of IGE, and little is known about basic epidemiology and long‐term outcome of drug‐resistant IGE. The aim of the study was to describe the incidence, prevalence and outcome of IGE in an unbiased, population‐based cohort. Methods In 2014–2018, all patients (≥17 years) with IGE inhabiting the island of Funen (496 000 inhabitants) were recruited. The socioeconomic and clinical information available for 406 individuals was assessed. Median follow‐up was 15 years. Results The average IGE incidence (2008–2017) was 2.9/100 000 inhabitants/year. The point prevalence of identifiable IGE patients was 1.0/1000 adults (juvenile myoclonic epilepsy 0.4/1000; absence epilepsy 0.3/1000, epilepsy with generalized tonic–clonic seizures alone 0.3/1000); 92.1% of the patients were diagnosed before 25 years of age. When correcting for unequal age distribution in the cohort, 1102 people on the island of Funen fulfilled the diagnostic criteria for IGE at the age of 25 (estimated prevalence 2.7/1000 adults). In the year before data closure, 121 patients reported seizures. Fifty patients met the definition of drug‐resistant IGE (12.1% of the cohort, 4.5% of the estimated 1102 IGE patients). The average seizure burden of all patients with drug‐resistant IGE was 2.2 generalized tonic–clonic seizures per year; only 14 patients suffered more than two generalized tonic–clonic seizures per year. Drug‐resistant IGE was associated with an increased risk of requiring treatment for affective disorders and a reduced probability of working full time. Conclusion Idiopathic generalized epilepsy was associated with a low risk of persistent drug‐resistant seizures requiring specialist medical attention. Drug resistance was associated with a negative socioeconomic outcome.

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“…A number of predictors of seizure recurrence have been identified, including once again, the duration of seizure freedom before antiepileptic drug discontinuation. This predictor was also shown in a study from the Berlin working group in 84 patients with genetic generalized epilepsy; when patients were seizure-free for less than 5 years before discontinuation, two-thirds had a recurrence, whereas when patients were seizure-free for longer, only one in three had a recurrence [62]. Since older age is associated with a greater likelihood of longer terminal seizure freedom in genetic generalized epilepsy, it is reasonable to assume that in older patients, discontinuation of the antiepileptic drug is associated with a lower risk of seizure recurrence compared with younger patients.…”

Section: Discontinuation Of Antiepileptic Drugsmentioning

confidence: 57%

Antiepileptic pharmacotherapy in old age: evidence-based approach versus clinical routine – English Version

Holtkamp

2022

Z. Epileptol.

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With respect to epilepsy in old age, two groups of patients with different needs and challenges must be distinguished, which are also treated separately in this article: those who have grown old with epilepsy and those with epilepsy occurring for the first time in older age. Diagnostically, the first group is unproblematic as there are only relatively rarely patients with a misdiagnosis of epilepsy that has been maintained over decades. In contrast, epilepsy beginning in older age is more often misdiagnosed or diagnosed with a delay because of the often comparatively harmless semiology including nonconvulsive status epilepticus. Therapeutically, the question of switching from an "old" antiepileptic drug with negative effects on electrolytes, hormones, bone density, hepatic and vitamin metabolism as well as on cognitive parameters, such as alertness and memory, to a "modern" agent frequently arises. While many of these newer compounds offer benefits there are always surprises with unexpected, particularly psychiatric, adverse effects. If the patient has been seizure-free for a long time, the question of discontinuing or at least reducing the dose of antiepileptic drugs naturally arises. At the onset of epilepsy in old age, the selection of an antiepileptic drug, which usually needs to be taken for the rest of the patient's life, requires special consideration of individual aspects, not least because of the often numerous comorbidities and already existing medications. The aim of this article is to present the current state of knowledge and to assist in the care of older patients in the area of conflict between the limited evidence-based data and the necessity of a therapeutic decision in routine clinical practice.

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Discontinuing antiepileptic drugs in long-standing idiopathic generalised epilepsy

Cited by 17 publications

References 16 publications

Seizure outcome trajectories in a well‐defined cohort of newly diagnosed juvenile myoclonic epilepsy patients

Seizure outcome trajectories in a well‐defined cohort of newly diagnosed juvenile myoclonic epilepsy patients

Epidemiology and outcome of idiopathic generalized epilepsy in adults

Antiepileptic pharmacotherapy in old age: evidence-based approach versus clinical routine – English Version

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