Rapid versus slow withdrawal of antiepileptic drugs

Loro, Fernando Ayuga; Tijeras, Enrique Gisbert; Brigo, Francesco

doi:10.1002/14651858.cd005003.pub4

Cited by 3 publications

(1 citation statement)

References 31 publications

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“…In the adult population, most reviews focused on mental disorders (17)(18)(19)(20)(21)(22)(23)(24) or chronic medical conditions (5,6,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Of the four reviews that addressed populations younger than 18 years, three focused on children and adolescents with mental disorders such as attention-deficit hyperactivity disorder (35,36) or epilepsy (37), and one review focused on paediatric patients with asthma (38). Most reviews focused on a group of medicines, most commonly medicines for mental disorders (15/70, 21 %), in particular benzodiazepines (13,16,(21)(22)(23) and antipsychotics (15,18,35,36).…”

Section: Reviews Describing Clinical and Humanistic Outcomes Of Depre...mentioning

confidence: 99%

Deprescribing: An umbrella review

Japelj,

Horvat,

Knez

et al. 2024

Acta Pharmaceutica

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This umbrella review examined systematic reviews of deprescribing studies by characteristics of intervention, population, medicine, and setting. Clinical and humanistic outcomes, barriers and facilitators, and tools for deprescribing are presented. The Medline database was used. The search was limited to systematic reviews and meta-analyses published in English up to April 2022. Reviews reporting deprescribing were included, while those where depre-scribing was not planned and supervised by a healthcare professional were excluded. A total of 94 systematic reviews (23 meta--analyses) were included. Most explored clinical or humanistic outcomes (70/94, 74 %); less explored attitudes, facilitators, or barriers to deprescribing (17/94, 18 %); few focused on tools (8/94, 8.5 %). Reviews assessing clinical or humanistic outcomes were divided into two groups: reviews with deprescribing intervention trials (39/70, 56 %; 16 reviewing specific deprescribing interventions and 23 broad medication optimisation interventions), and reviews with medication cessation trials (31/70, 44 %). Deprescribing was feasible and resulted in a reduction of inappropriate medications in reviews with deprescribing intervention trials. Complex broad medication optimisation interventions were shown to reduce hospitalisation, falls, and mortality rates. In reviews of medication cessation trials, a higher frequency of adverse drug withdrawal events underscores the importance of prioritizing patient safety and exercising caution when stopping medicines, particularly in patients with clear and appropriate indications.

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Section: Reviews Describing Clinical and Humanistic Outcomes Of Depre...mentioning

confidence: 99%

Deprescribing: An umbrella review

Japelj,

Horvat,

Knez

et al. 2024

Acta Pharmaceutica

View full text Add to dashboard Cite

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Achieving sustainable healthcare through deprescribing

Gnjidic

Johansson²,

Meng

et al. 2022

Cochrane Database of Systematic Reviews

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Video-EEG-monitoring to guide antiseizure medication withdrawal

Dhaenens-Meyer,

Schriewer,

Weber

et al. 2023

Neurol. Res. Pract.

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Background Discontinuing anti-seizure medication (ASM) should be considered in persons with epilepsy with long-term seizure freedom. Clinicians should also pursue ASM withdrawal in persons with one-time seizures without increased recurrence risk and those with suspected non-epileptic events. However, ASM withdrawal is associated with the risk of recurring seizures. Monitored ASM withdrawal in an epilepsy monitoring unit (EMU) could help better evaluate the risk of seizure recurrence. Here, we investigate the practice of EMU-guided ASM withdrawal, assess its indications, and aim to determine positive and negative predictors for successful withdrawal. Methods We screened the medical records of all patients admitted to our EMU between November 1, 2019, and October 31, 2021, and included patients of at least 18 years admitted with the aim of permanent ASM withdrawal. We defined four groups of withdrawal indications: (1) long-term seizure freedom; (2) suspected non-epileptic events; (3) history of epileptic seizures but not fulfilling diagnostic criteria of epilepsy; and (4) seizure-freedom after epilepsy surgery. Successful withdrawal was defined according to the following criteria: no recoding of (sub)clinical seizure activity during VEM (groups 1, 2, and 3), patients did not meet the International League Against Epilepsy (ILAE) definition of epilepsy (groups 2 and 3) [14], and patients were discharged without ongoing ASM treatment (all groups). We also evaluated the prediction model by Lamberink et al. (LPM) for the risk of seizure recurrence in groups 1 and 3. Results 55/651 (8.6%) patients fulfilled the inclusion criteria. Withdrawal indications were distributed as follows; group 1: 2/55 (3.6%); group 2: 44/55 (80%); group 3: 9/55 (16,4%); group 4: 0/55. Overall, ASM withdrawal was successful in 90.9%. The sensitivity of the LPM for a 2-year 50% relapse risk threshold was 75%, the specificity 33.3%; for a 5-year relapse risk respectively 12.5% and 33.3%, suggesting that the model is not suitable for risk assessment in patients with one-time seizures or acute-symptomatic seizures, who constituted most of the evaluated patients. Conclusions Our study suggests that EMU-guided ASM withdrawal could be a helpful tool to support clinical decision-making and improve patient safety. Prospective, randomized trials should further evaluate this method in the future.

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Rapid versus slow withdrawal of antiepileptic drugs

Abstract: MethodsRandomized, unblinded, prospective study Inclusion criteria: diagnosis of epilepsy and seizure control by an AED for ≥ 2 years.2 study arms: 1-month AED withdrawal group (rapid tapering) or 6-month AED withdrawal group (slow tapering).Type of randomization not specified.

Cited by 3 publications

References 31 publications

Deprescribing: An umbrella review

Deprescribing: An umbrella review

Achieving sustainable healthcare through deprescribing

Video-EEG-monitoring to guide antiseizure medication withdrawal

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