Risk of seizure relapse after antiepileptic drug withdrawal in adult patients with focal epilepsy

He, Ruqian; Qing-yuan, Zeng; Zhu, Pan; Bao, Yixin; Zheng, Ran; Xu, Huiqin

doi:10.1016/j.yebeh.2016.08.006

Cited by 19 publications

(12 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Only three of the 15 studies investigated the rate of withdrawal. All three studies were prospective studies in which patients with a remission duration of 2 years or more gradually withdrew from AEDs over 6 months or more; the recurrence rates were 22.8%, 49.1%, and 49.5%, respectively [27,29,30]. Two studies reported higher recurrence rates in patients with a remission period of 4 years or more who gradually withdrew from AEDs over a longer period of time [34,35], while cohort studies of patients with a remission period of 6 (inclusive) to 12 months who gradually withdrew from AEDs over a shorter period reported lower recurrence rates [23][24][25][26].…”

Section: Recurrence Rate In Different Patients With Epilepsy After Aed Withdrawalmentioning

confidence: 99%

“…Several studies have shown that patients with focal seizures are susceptible to recurrence after AED withdrawal [27,30,[57][58][59][60][61][62]. According to Hawash et al [58], three-quarters of patients with recurrence after AED withdrawal experienced focal seizures with or without generalized seizures.…”

Section: Types Of Seizuresmentioning

confidence: 99%

“…Schmidt and Löscher [59] conducted a meta-analysis of 14 studies in children and adult patients with epilepsy and found that focal epilepsy was a risk factor for recurrence after AED withdrawal in patients with epilepsy. He et al [30] conducted a study with a followup period of 1 year or more in 200 adult patients with focal epilepsy who were seizure-free for at least 2 years. The overall recurrence rate was 49.5% after AED withdrawal, and 79.8% of patients with recurrence experienced the recurrence during the first 2 years, whereas few patients experienced recurrence after 5 years of withdrawal (b 1%).…”

Section: Types Of Seizuresmentioning

confidence: 99%

See 2 more Smart Citations

Prediction of the recurrence risk in patients with epilepsy after the withdrawal of antiepileptic drugs

Yang

Zhang

Long

et al. 2020

Epilepsy & Behavior

View full text Add to dashboard Cite

Many seizure-free patients who consider withdrawing from antiepileptic drugs (AEDs) hope to discontinue treatment to avoid adverse effects. However, withdrawal has certain risks that are difficult to predict. In this study, we performed a literature review, summarized the causes of significant variability in the risk of postwithdrawal recurrent seizures, and reviewed study data on the age at onset, cause, types of seizures, epilepsy syndrome, magnetic resonance imaging (MRI) abnormalities, epilepsy surgery, and withdrawal outcomes of patients with epilepsy. Many factors are associated with recurrent seizures after AED withdrawal. For patients who are seizure-free after treatment, the role of an electroencephalogram (EEG) alone in ensuring safe withdrawal is limited. A series of prediction models for the postwithdrawal recurrence risk have incorporated various potentially important factors in a comprehensive analysis. We focused on the populations of studies investigating five risk prediction models and analyzed the predictive variables and recommended applications of each model, aiming to provide a reference for personalized withdrawal for patients with epilepsy in clinical practice.

show abstract

Section: Recurrence Rate In Different Patients With Epilepsy After Aed Withdrawalmentioning

confidence: 99%

Section: Types Of Seizuresmentioning

confidence: 99%

Section: Types Of Seizuresmentioning

confidence: 99%

See 1 more Smart Citation

Prediction of the recurrence risk in patients with epilepsy after the withdrawal of antiepileptic drugs

Yang

Zhang

Long

et al. 2020

Epilepsy & Behavior

View full text Add to dashboard Cite

show abstract

“…Consequently, the age at first seizure onset is positively correlated with seizure relapse after ASM withdrawal. In addition, many studies have reported that the duration of epilepsy before treatment and the duration of active epilepsy were significantly correlated with seizure relapse after ASM withdrawal ( 23 , 24 , 34 , 36 ). The duration of active epilepsy is related to the severity of the disease.…”

Section: Discussionmentioning

confidence: 99%

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.

View full text Add to dashboard Cite

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.

show abstract

“…The duration of antiepileptic therapy in post-infectious epilepsy should be customarized. It is reasonable to consider AEDs withdrawal in those who has been seizure-free for at least 2 years [88,[92][93][94]. In addition, it is commonly accepted that antiepileptic therapy be initiated once the diagnosis of SE is established.…”

Section: Clinical Management and Prognosismentioning

confidence: 99%

Seizures and epilepsy secondary to viral infection in the central nervous system

Zhang

Yang

Zou

et al. 2020

Acta Epileptologica

View full text Add to dashboard Cite

Viral infection in the central nervous system (CNS) is a common cause of seizures and epilepsy. Acute symptomatic seizures can occur in the context of almost all types of acute CNS viral infection. However, late unprovoked seizures and epilepsy may not be frequent after viral infection of the CNS. The incidence of seizures and epilepsy after CNS viral infection is mainly dependent on the brain region of infection. It remains to be determined whether treatment of CNS viral infection using antiepileptic drugs (AEDs) can prevent seizures and subsequent epilepsy in patients, particularly with regard to the timing, drug choice and dosage, and duration of AEDs. The postoperative outcome of seizures in patients with intractable epilepsy caused by viral encephalitis primarily depends on the epileptogenic zone. In addition, neuroinflammation is known to be widely involved in the generation of seizures during CNS viral infection, and the effects of anti-inflammatory therapies in preventing seizures and epilepsy secondary to CNS viral infection require further studies. In this review, we discuss the incidence, mechanisms, clinical management and prognosis of seizures and epilepsy secondary to CNS viral infection, and summarize common CNS viral infections that cause seizures and epilepsy.

show abstract

Risk of seizure relapse after antiepileptic drug withdrawal in adult patients with focal epilepsy

Cited by 19 publications

References 30 publications

Prediction of the recurrence risk in patients with epilepsy after the withdrawal of antiepileptic drugs

Prediction of the recurrence risk in patients with epilepsy after the withdrawal of antiepileptic drugs

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

Seizures and epilepsy secondary to viral infection in the central nervous system

Contact Info

Product

Resources

About