Is rapid withdrawal of anti-epileptic drug therapy during video EEG monitoring safe and efficacious?

Rizvi, Syed A. A.; Hernández-Ronquillo, Lizbeth; Wu, Aihua; Zenteno, José Francisco Téllez

doi:10.1016/j.eplepsyres.2014.01.022

Cited by 38 publications

(35 citation statements)

References 16 publications

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“…FBTCS are, however, far more frequent than status epilepticus during VEM and are significantly related to physical injuries and sudden unexpected death in epilepsy (or SUDEP). Previous studies dealing with FBTCS during VEM included between 54 and 151 patients, with 18% to 57% of them having FBTCS during VEM . The proportion of people with FBTCS in our study (2014/15: 28%; 2004/05: 29%) was largely within the range reported by other studies.…”

Section: Discussionsupporting

confidence: 78%

Predictors of focal to bilateral tonic‐clonic seizures during long‐term video‐EEG monitoring

et al. 2020

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Objective To determine predictors of focal to bilateral tonic‐clonic seizures (FBTCS) during video–electroencephalography (EEG) monitoring (VEM). Methods All adult patients undergoing presurgical VEM from 2014 to 2015 in the department of epileptology were eligible (N = 229). Those with refractory focal epilepsy and epileptic seizures recorded during VEM were analyzed (N = 188, Group 1). To assess the effects of antiepileptic drug (AED) taper, the total AED load was calculated as the sum of the ratios of prescribed daily dose and defined daily dose of all AEDs per VEM day and was correlated with the occurrence of focal seizures without bilateral tonic‐clonic seizures (FwoBTCS) and FBTCS. To validate the findings, data of patients undergoing VEM in 2004 and 2005 (Group 2, eligible N = 243, analyzed N = 203) were also investigated. Results In Group 1, 53 patients had FBTCS and 135 patients had exclusively FwoBTCS during VEM. Reduced AED load at seizure onset was the most important modifiable risk factor for FBTCS (receiver‐operating characteristic [ROC]: area under the curve [AUC] = 0.78). Furthermore, the risk of FBTCS varied with the history and frequency of FBTCS prior to VEM. For instance, patients had a 50% risk of FBTCS by reducing the AED load to ~20% when no information about history of FBTCS was taken into account, to ~30% when a positive history of FBTCS was taken into account, and to ~50% when a high frequency of FBTCS prior to VEM was taken into account. These findings were largely replicated in Group 2 (59 patients with FBTCS and 144 exclusively with FwoBTCS). Significance The risk of FTBCS during VEM depends on the history and frequency of FTBCS prior to VEM and is particularly associated with the extent of AED reduction. Our data underscore the need for appropriate tapering regimens in VEM units.

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Section: Discussionsupporting

confidence: 78%

Predictors of focal to bilateral tonic‐clonic seizures during long‐term video‐EEG monitoring

et al. 2020

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“…Previous studies showed clustering of three or more seizures within 24 h in 39.0–48.5%, those within 4 h in 11.0–17.8%, unexpected secondarily GTCS in 7.4–9.0%, and status epilepticus in 0–3.0% during vEEG . Our protocol presented similar adverse events during only vEEG, however, not in PMA.…”

Section: Discussionsupporting

confidence: 65%

“…Henning et al described a large variation in patterns and paces of AED withdrawal. Previous reports applying AED withdrawal showed 81.0–92.6% diagnostic yield, with one or more seizures confirmed in the monitored adult patients with infrequent seizures . There were various patterns of AED withdrawal in each institution.…”

Section: Prolonged Video‐eegmentioning

confidence: 83%

Effective withdrawal of antiepileptic drugs in premonitoring admission to capture seizures during limited video‐EEG monitoring

et al. 2017

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SummaryObjectiveWithdrawal of antiepileptic drugs (AEDs) is commonly applied to capture seizures in video‐EEG (vEEG) monitoring for patients with infrequent but intractable seizures. Because of the half‐life of AEDs, AED withdrawal during only vEEG tends to be inadequate to provoke seizures within the vEEG admission. We hypothesize that prewithdrawal of long‐half‐life AEDs in premonitoring admission (PMA) is safe and effective to capture seizures in the limited time of vEEG. We determined the effect of half‐life on the interval between AED withdrawal and seizure occurrence.MethodsWe collected 87 patients with three criteria: (1) seizure occurrence ≤3 per month; (2) AEDs ≥2; (3) AED withdrawal during their admission, among 126 consecutive patients who underwent vEEG in the Department of Neurosurgery, Hiroshima University Hospital between 2011 and 2014. We divided patients into two groups on the basis of half‐life of AED: Group A (23 patients) with phenobarbital (PB) and/or zonisamide (ZNS); Group B (64 patients) with other AEDs. In Group A, PB and ZNS were withdrawn during 4‐day PMA before vEEG started. Further AED withdrawal was performed during vEEG, depending on the seizure occurrence.ResultsThe number of AEDs on admission was significantly higher in Group A (2–6, 3.5 ± 0.9; range, mean ±SD) than in Group B (2–5, 2.8 ± 0.8) (p < 0.01). All 23 Group A patients and 13 (20%) Group B patients underwent AED withdrawal during PMA. Seizures occurred during PMA in two patients in both Group A (9%) and Group B (15%). The first seizure occurred significantly longer after the start of withdrawal in Group A (6.1 ± 2.0 days) than in Group B (2.8 ± 1.3 days) (p < 0.01). Seizures were equally captured between both groups: 96% in Group A and 92% in Group B during vEEG.SignificanceFor epilepsy patients who are treated with PB and/or ZNS, we recommend the planning of AED withdrawal during PMA before the start of vEEG to succeed in capturing seizures during the limited time of vEEG monitoring.

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“…This implies that implantation of intracranial electrodes may alter brain physiology, as suggested by the "implantation effect" after placement of intracerebral stimulators in prior studies [2][3][4]. Although prior studies have proven that rapid AED withdrawal is safe during scalp video EEG monitoring,22 it is not yet known whether the AEDs can be safely decreased at a faster rate during iEEG monitoring and this Also important is minimizing the number of electrode contacts to ensure that seizure capture is performed in a timely fashion.…”

mentioning

confidence: 99%

The implantation effect: delay in seizure occurrence with implantation of intracranial electrodes

Lane

Kahlenberg

et al. 2016

Acta Neurol Scand

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Is rapid withdrawal of anti-epileptic drug therapy during video EEG monitoring safe and efficacious?

Cited by 38 publications

References 16 publications

Predictors of focal to bilateral tonic‐clonic seizures during long‐term video‐EEG monitoring

Predictors of focal to bilateral tonic‐clonic seizures during long‐term video‐EEG monitoring

Effective withdrawal of antiepileptic drugs in premonitoring admission to capture seizures during limited video‐EEG monitoring

The implantation effect: delay in seizure occurrence with implantation of intracranial electrodes

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