Drug withdrawal in patients with epilepsy: prognostic value of the EEG

Galimberti, Carlo; Manni, Raffaele; Parietti, L.; Marchioni, Enrico; Tártara, A

doi:10.1016/s1059-1311(05)80130-x

Cited by 32 publications

(19 citation statements)

References 19 publications

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“…In a cohort of 97 children who were seizure free for 12 months, age at seizure onset over 10 years was associated with a higher risk of seizure recurrence (Dooley et al., ). This finding was confirmed by a study in 136 adult patients (Galimberti et al., ) in whom age older than 12 years at disease onset was a negative prognostic indicator. The systematic review by Berg and Shinnar () found adolescent‐onset epilepsy to carry a higher risk of relapse (relative risk 1.79, 95% CI 1.46–2.19) compared to childhood‐onset epilepsy; the corresponding value for adult‐onset epilepsy was 1.34 (95% CI 1.00–1.81).…”

Section: Question 5: Should Age At Onset Be a Factor Influencing The mentioning

confidence: 64%

Withdrawal of antiepileptic drugs: Guidelines of the Italian League Against Epilepsy

et al. 2013

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SUMMARYThe Italian League Against Epilepsy has issued evidence-based guidelines to help practicing physicians in their decision to stop or withhold antiepileptic drugs (AEDs) in patients achieving a prolonged period of seizure freedom. Six adult and two child neurologists, divided into four pairs, critically appraised 128 published reports and provided graded recommendations answering 15 key questions: length of the seizure-free period after treatment initiation, difference in seizure-free periods in children and adults, electroencephalography (EEG) pattern at the time of discontinuation, etiology of epilepsy, seizure type(s), patient's age and sex, family history of epilepsy, history of febrile seizures, epilepsy syndrome, seizure frequency before entering remission, duration of active epilepsy, tapering period, number and type of AEDs taken at time of discontinuation, combination of risk factors for recurrence, and length of patient monitoring after treatment discontinuation. Based on the available data, the following recommendations can be outlined: (1) antiepileptic treatment might be discontinued after a minimum period of 2 years of seizure freedom; shorter seizure-free periods are associated to a higher risk of relapse; (2) in children, AED discontinuation could be considered after less than two seizurefree years because of a marginally higher risk of relapse for early withdrawal; (3) factors, such as abnormal EEG (including epileptiform abnormalities) at the time of treatment discontinuation, a documented etiology of seizures (including mental retardation, perinatal insults, and abnormal neurologic examination), partial seizures, or an older age at disease onset, enhance the risk of relapse; however, patients should not be encouraged to withhold treatment unless a combination of two or more of these factors is present; (4) female sex, family history of epilepsy, history of febrile seizures, disease length/severity, and number and type of drugs taken should not influence the decision to stop treatment; (5) epilepsy syndrome should be always included in the decision process; (6) slow (at least 6 months) AED discontinuation should be encouraged; in any case the duration of the tapering period should be tailored to the patient's needs and preference; and (7) patient discontinuing treatment should be followed for no <2 years. As a general habit, the decision to stop treatment should be discussed and shared with each patient, taking into account social and personal complications of a seizure relapse and the medical complications of chronic AED treatment.

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Section: Question 5: Should Age At Onset Be a Factor Influencing The mentioning

confidence: 64%

Withdrawal of antiepileptic drugs: Guidelines of the Italian League Against Epilepsy

et al. 2013

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“…Between 60% and 75% of children and adults with epilepsy who have been seizure free on medications for more than 2 or 4 years remain seizure free following discontinuation of therapy. [111][112][113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128] A meta-analysis of the literature available in 1994 found a pooled relapse risk of 25% at 1 year and 29% at 2 years following antiepileptic drug withdrawal. 113 Prognosis following medication withdrawal was similar whether a 2-year 112,114,115,120,[124][125][126][127] or 4-year 116,118,119,121,124,127 seizure-free interval was used.…”

Section: Prognosis Following Discontinuation Of Antiepileptic Drug Thmentioning

confidence: 99%

Update on the Epidemiology and Prognosis of Pediatric Epilepsy

2002

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Epilepsy is among the most common serious neurologic disorders in childhood. Epidemiologic studies over the past few decades have greatly increased current knowledge of the incidence and prognosis of seizures. Newer epidemiologic studies have used population- or community-based cohorts, and careful attention has been given to etiology and specific epilepsy syndromes, the two most important factors affecting prognosis. Risk of epilepsy is highest in patients with an associated serious neurologic abnormality, such as mental retardation or cerebral palsy. More than two thirds of patients with childhood-onset epilepsy ultimately achieve remission. Of those attaining remission on medications, approximately 70% remain seizure free when medications are discontinued. Mortality is increased in patients with epilepsy, but the increased mortality risk in childhood-onset epilepsy is primarily seen in patients with neurologic abnormalities or intractable epilepsy. Although long-term seizure outcomes are generally favorable, childhood-onset epilepsy is associated with adverse long-term psychosocial outcomes, even in patients attaining remission. This review summarizes recent data on the epidemiology and prognosis of pediatric epilepsy.

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“…Several studies of adults and children with epilepsy have reported on the results of AED withdrawal and the factors that predict relapse after withdrawal [1][2][3][4][5][6] .…”

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confidence: 99%