Evaluating the Rate of Recurrence of Epilepsy after Therapy Discontinuation in 2-Year Seizure-Free Epileptic Patients

Afshari, Daryoush; Moradian, Nasrin

doi:10.3109/00207454.2012.694936

Cited by 8 publications

(8 citation statements)

References 16 publications

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“…Several recent studies have investigated the relationship between seizure relapse and the number of ASMs in patients with ASM withdrawal, but there has been no consistent conclusion. Our results demonstrated that patients treated with polytherapy had a higher seizure relapse risk than those with monotherapy (HR = 2.152, 95% CI = 1.350-3.428), which was in line with previous studies (23,(30)(31)(32). We also found that the risk of early recurrence (within the first 6 months) in polytherapy-treated patients was significantly higher than that of the monotherapy group (22.6 vs. 9.6%, p = 0.018).…”

Section: Discussionsupporting

confidence: 92%

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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Section: Discussionsupporting

confidence: 92%

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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“…Predictors for seizure recurrence after a minimum remission of 2 years in patients with a history of epilepsy include AED polytherapy, having experienced seizures after the start of AED treatment, longer duration of active epilepsy, and having an abnormal electroencephalogram (EEG) [58,62,63]. Especially, a history of primary or secondary generalized tonic-clonic seizures is found to be a risk factor for seizure recurrence after withdrawal, although some studies report that focal seizures are an independent predictor for relapse as well [6,59,62,64]. Moreover, the risk of seizure recurrence is reported to depend on the specific AED being withdrawn, with a particularly high risk of relapse after discontinuation of phenobarbital [65].…”

Section: Withdrawal In Patients Treated With Aeds Onlymentioning

confidence: 99%

“…A higher risk of seizure recurrence in patients with focal epilepsy might be related to an underlying etiology. In the larger withdrawal studies in patients with epilepsy treated with AEDs only, presence of an underlying neurological condition or abnormalities on computed tomography scan has been associated with a higher relapse risk after AED discontinuation [6,64]. According to the guidelines of the Italian League Against Epilepsy, a documented etiology of seizures is of limited relevance when deciding to discontinue AEDs, if this is the only negative prognostic factor [62].…”

Section: Withdrawal In Patients Treated With Aeds Onlymentioning

confidence: 99%

“…In patients who achieve seizure freedom, chronic use of AEDs may lead to an additional decrease in neurocognitive functioning, apart from the effect of the tumor itself and toxicities due to antitumor treatment [3]. Moreover, drug-drug interactions and other adverse effects of AEDs make long-term treatment with these agents potentially risky with numerous morbidities [6].…”

Section: Introductionmentioning

confidence: 99%

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The withdrawal of antiepileptic drugs in patients with low-grade and anaplastic glioma

Koekkoek

Dirven

Taphoorn

2016

Expert Review of Neurotherapeutics

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The withdrawal of antiepileptic drugs (AEDs) in World Health Organization (WHO) grade II-III glioma patients with epilepsy is controversial, as the presence of a symptomatic lesion is often related to an increased risk of seizure relapse. However, some glioma patients may achieve long-term seizure freedom after antitumor treatment, raising questions about the necessity to continue AEDs, particularly when patients experience serious drug side effects. Areas covered: In this review, we show the evidence in the literature from 1990-2016 for AED withdrawal in glioma patients. We put this issue into the context of risk factors for developing seizures in glioma, adverse effects of AEDs, seizure outcome after antitumor treatment, and outcome after AED withdrawal in patients with non-brain tumor related epilepsy. Expert commentary: There is currently scarce evidence of the feasibility of AED withdrawal in glioma patients. AED withdrawal could be considered in patients with grade II-III glioma with a favorable prognosis, who have achieved stable disease and long-term seizure freedom. The potential benefits of AED withdrawal need to be carefully weighed against the presumed risk of seizure recurrence in a shared decision-making process by both the clinical physician and the patient.

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“…In patients with non-tumour-related epilepsy AEDs are generally discontinued some time after successful epilepsy surgery [ 18 ],[ 27 ],[ 28 ]. AED withdrawal following temporal lobe resection in patients with refractory non-tumoural epilepsy eventually leads to seizure freedom without use of AEDs in 77% of patients [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

Withdrawal of antiepileptic drugs in glioma patients after long-term seizure freedom: design of a prospective observational study

et al. 2014

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BackgroundEpilepsy is common in patients with a glioma. Antiepileptic drugs (AEDs) are the mainstay of epilepsy treatment, but may cause side effects and may negatively impact neurocognitive functioning and quality of life. Besides antiepileptic drugs, anti-tumour treatment, which currently consists of surgery, radiotherapy and/or chemotherapy, may contribute to seizure control as well. In glioma patients with seizure freedom after anti-tumour therapy the question emerges whether AEDs should be continued, particularly in the case where anti-tumour treatment has been successful. We propose to explore the possibility of AED withdrawal in glioma patients with long-term seizure freedom after anti-tumour therapy and without signs of tumour progression.Methods/DesignWe initiate a prospective, observational study exploring the decision-making process on the withdrawal or continuation of AEDs in low-grade and anaplastic glioma patients with stable disease and prolonged seizure freedom after anti-tumour treatment, and the effects of AED withdrawal or continuation on seizure freedom. We recruit participants through the outpatient clinics of three tertiary referral centers for brain tumour patients in The Netherlands. The patient and the treating physician make a shared decision to either withdraw or continue AED treatment. Over a one-year period, we aim to include 100 glioma patients. We expect approximately half of the participants to be willing to withdraw AEDs. The primary outcome measures are: 1) the outcome of the shared-decision making on AED withdrawal or continuation, and decision related arguments, and 2) seizure freedom at 12 months and 24 months of follow-up. We will also evaluate seizure type and frequency in case of seizure recurrence, as well as neurological symptoms, adverse effects related to AED treatment or withdrawal, other anti-tumour treatments and tumour progression.DiscussionThis study addresses two issues that are currently unexplored. First, it will explore the willingness to withdraw AEDs in glioma patients, and second, it will assess the risk of seizure recurrence in case AEDs are withdrawn in this specific patient population. This study aims to contribute to a more tailored AED treatment, and prevent unnecessary and potentially harmful use of AEDs in glioma patients.

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Evaluating the Rate of Recurrence of Epilepsy after Therapy Discontinuation in 2-Year Seizure-Free Epileptic Patients

Cited by 8 publications

References 16 publications

Comparison of Long-Term Outcomes of Monotherapy and Polytherapy in Seizure-Free Patients With Epilepsy Following Antiseizure Medication Withdrawal

Comparison of Long-Term Outcomes of Monotherapy and Polytherapy in Seizure-Free Patients With Epilepsy Following Antiseizure Medication Withdrawal

The withdrawal of antiepileptic drugs in patients with low-grade and anaplastic glioma

Withdrawal of antiepileptic drugs in glioma patients after long-term seizure freedom: design of a prospective observational study

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