Individualised prediction model of seizure recurrence and long-term outcomes after withdrawal of antiepileptic drugs in seizure-free patients: a systematic review and individual participant data meta-analysis

Lamberink, Herm J.; Otte, Willem M.; Geerts, Ada T.; Pavlović, Milen; Ramos-Lizana, Julio; Marson, Anthony G; Overweg, J.; Sauma, Letícia; Specchio, Luigi Maria; Tennison, Michael B.; Cardoso, Tânia Marchiori; Shinnar, Shlomo; Schmidt, Dieter; Geleijns, Karin; Braun, Kees P.J.

doi:10.1016/s1474-4422(17)30114-x

Cited by 240 publications

(333 citation statements)

References 33 publications

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“…In human medicine, focal seizures are associated with seizure recurrence not only in PEE but also in other types of epilepsies . In this study, 42% of dogs experienced both generalized and focal seizures and 21% had only focal seizures.…”

Section: Discussionmentioning

confidence: 53%

Postencephalitic epilepsy in dogs with meningoencephalitis of unknown origin: Clinical features, risk factors, and long‐term outcome

Kaczmarska

José-López

Czopowicz

et al. 2020

Veterinary Internal Medicne

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Background Although the presence of seizures in dogs with meningoencephalitis of unknown origin (MUO) has been associated with shorter survival times, data regarding the prevalence and risk factors for postencephalitic epilepsy (PEE) is lacking. Objectives To describe the clinical features, prevalence, risk factors, and long‐term outcome of PEE in dogs with MUO. Animals Sixty‐one dogs with presumptive diagnosis of MUO based on the clinicopathological and diagnostic imaging findings. Methods Retrospective study. Cases were identified by search of hospital medical records for dogs with suspected or confirmed MUO. Medical records of dogs meeting inclusion criteria were reviewed. Signalment, seizure history, clinicopathologic, and magnetic resonance imaging (MRI) findings were recorded. Results Among 61 dogs at risk of PEE, 14 (23%) dogs developed PEE. Three of 14 dogs with PEE (21%) developed drug‐resistant epilepsy. Dogs with PEE were younger (P = .03; ORadjusted = 0.75; 95% confidence interval [CI], 0.58‐0.98) and had significantly shorter survival times (log‐rank test P = .04) when compared to dogs that did not develop epilepsy. The risk factors associated with the development of PEE were the presence of acute symptomatic seizures (ASS; P = .04; ORadjusted = 4.76; 95% CI, 1.11‐20.4) and MRI lesions in the hippocampus (P = .04; ORadjusted = 4.75; 95% CI, 1.07‐21.0). Conclusions and Clinical Importance Dogs with MUO and seizures at the early stage of the disease (ASS) seem to be at a higher risk of developing PEE.

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Section: Discussionmentioning

confidence: 53%

Postencephalitic epilepsy in dogs with meningoencephalitis of unknown origin: Clinical features, risk factors, and long‐term outcome

Kaczmarska

José-López

Czopowicz

et al. 2020

Veterinary Internal Medicne

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“…It is important to emphasize that our study focused on patients with NOSE; thus, it is difficult to compare our results to most other studies, which investigated both pediatric and adult populations with and without a previous history of epilepsy, with and without SE. Among these studies, seizure recurrence in the setting of ASD weaning ranged from 12% to 66% . One study found an average recurrence rate of one‐third; however, there was no difference in long‐term outcomes .…”

Section: Discussionmentioning

confidence: 99%

“…Once seizure control is achieved in NOSE, patients may be discharged on multiple ASDs, which are medications that carry a high burden of side effects and psychosocial implications for patients . Successful weaning from ASDs in the inpatient setting has been shown, as well as in patients with epilepsy who have been seizure‐free for prolonged periods of time in the outpatient setting, but there is a paucity of data on the safety of discontinuing ASDs in NOSE after hospital discharge. There is a specific reluctance to wean patients off of barbiturate medications due to the possibility for seizure recurrence during withdrawal .…”

Section: Introductionmentioning

confidence: 99%

Weaning from antiseizure drugs after new onset status epilepticus

Chakraborty

Hocker

2019

Epilepsia

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Summary Objective In patients with status epilepticus (SE) without prior epilepsy, there are limited data on the safety of discontinuing antiseizure drugs (ASDs) after seizure control. We aimed to describe seizure recurrence when weaning from ASDs following new onset SE (NOSE). Methods Retrospective review of adult patients with NOSE admitted to Mayo Clinic, Rochester, Minnesota between January 1, 1990 and December 31, 2015 was performed. Weaning was defined as a discontinuation of ASDs following discharge. Patient demographics, SE characteristics, timing of ASD withdrawal, and seizure recurrence were collected. Results One hundred seventy‐seven patients with mean age 63 ± 18 years were identified; 96 (54.2%) patients had refractory SE (RSE), and 81 (45.8%) had nonrefractory SE. Mean follow‐up was 3.8 ± 3.2 years for those successfully weaned off ASDs. One hundred thirty (73.4%) with outpatient follow‐up were included in the analysis; 128 (98.5%) patients were discharged on an ASD; 44 of 128 (34.4%) patients underwent weaning from at least 1 ASD following discharge, including 27 of 128 (21.1%) who were completely weaned off of all ASDs. Younger patients (P = 0.009) and those with RSE (P = 0.048, odds ratio = 2.12, 95% confidence interval = 1.00‐4.48) tended to undergo weaning. Six of 44 (13.6%) patients had seizure recurrence when weaned off of any ASD, and two of 27 (7.4%) patients completely weaned off all ASDs had seizure recurrence. Two of seven (28.6%) patients who underwent attempted barbiturate weaning experienced seizure recurrence. Significance We found a rate of 13.6% for late seizure recurrence after weaning from at least one ASD in patients with NOSE; seizure recurrence was more likely in patients with RSE treated with barbiturates. Systematic collection of longitudinal data in patients requiring multiple ASDs for NOSE control will provide more conclusive guidance on weaning from ASDs.

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“…25 For diseases of the brain too, the ability to predict better (or worse) outcomes has been achieved by collating multiple markers, with higher numbers of markers performing better. [26][27][28][29] This strategy might be effective in psychiatry also. 30 Endophenotypes constructed from multiple social, clinical and brain volumetric alterations identified subgroups of patients that crossed diagnoses (n = 1872).…”

Section: What Next?mentioning

confidence: 99%

Neuroimaging tests for clinical psychiatry: Are we there yet?

Leyton

Kennedy

2017

JPN

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Individualised prediction model of seizure recurrence and long-term outcomes after withdrawal of antiepileptic drugs in seizure-free patients: a systematic review and individual participant data meta-analysis

Abstract: Background. People with epilepsy who became seizure-free while taking antiepileptic drugs (AEDs) may

Cited by 240 publications

References 33 publications

Postencephalitic epilepsy in dogs with meningoencephalitis of unknown origin: Clinical features, risk factors, and long‐term outcome

Postencephalitic epilepsy in dogs with meningoencephalitis of unknown origin: Clinical features, risk factors, and long‐term outcome

Weaning from antiseizure drugs after new onset status epilepticus

Neuroimaging tests for clinical psychiatry: Are we there yet?

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