Uncontrolled epilepsy following discontinuation of antiepileptic drugs in seizure-free patients: a review of current clinical experience

Schmidt, Dieter; Löscher, Wolfgang

doi:10.1111/j.1600-0404.2005.00408.x

Cited by 103 publications

(77 citation statements)

References 77 publications

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“…From those who experience seizure recurrence, about 80% will be able to control seizures by reinstating AED treatment 6 . The remaining 20% of people will develop treatment refractory epilepsy, although there is no convincing evidence that this refractoriness occurs as a consequence of AED withdrawal.…”

Section: Introductionmentioning

confidence: 99%

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

Otte

Geerts

et al. 2017

The Lancet Neurology

242

279

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Section: Introductionmentioning

confidence: 99%

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

Otte

Geerts

et al. 2017

The Lancet Neurology

242

279

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show abstract

“…Up to 23% of those discontinuing treatment go on to develop intractable epilepsy. Risk factors for subsequent poor treatment outcome are symptomatic focal epilepsy and cognitive deficits (Chadwick et al 1996;Schmidt and Löscher 2005). Finally, 5% of those with refractory epilepsy will achieve a remission of 12 mo when medication is adjusted, although about onehalf will subsequently relapse (Neligan et al 2012).…”

Section: Prognosismentioning

confidence: 99%

Seizures and Epilepsy: An Overview for Neuroscientists

Stafstrom

Carmant²

2015

Cold Spring Harbor Perspectives in Medicine

651

421

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Epilepsy is one of the most common and disabling neurologic conditions, yet we have an incomplete understanding of the detailed pathophysiology and, thus, treatment rationale for much of epilepsy. This article reviews the clinical aspects of seizures and epilepsy with the goal of providing neuroscientists an introduction to aspects that might be amenable to scientific investigation. Seizures and epilepsy are defined, diagnostic methods are reviewed, various clinical syndromes are discussed, and aspects of differential diagnosis, treatment, and prognosis are considered to enable neuroscientists to formulate basic and translational research questions.T his article provides an overview of seizures and epilepsy for neuroscientists. We focus on broad concepts, rather than clinical details, and raise questions related to mechanisms, epileptogenesis, and therapeutic approaches that might generate interest among basic researchers. Further information about differential diagnosis, drug doses, and clinical management are available from numerous resources (Engel and Pedley 2008;Duchowny et al. 2012;Engel 2013).We first define seizures and epilepsy and summarize their classification, pathophysiology, and genetics. Diagnostic methods are then considered, including the importance of an accurate historical description of an event suspected to be a seizure and the appropriate use of ancillary/confirmative tests, such as electroencephalogram (EEG), neuroimaging, and genetic studies. These modalities enable the clinician to differentiate epilepsy from numerous clinical conditions that mimic seizures, but have a nonepileptic pathophysiological basis. Examples of epilepsy syndromes are then described, selected based on their frequency in the population or because they embody scientific questions that warrant elucidation. Finally, we provide an overview of treatment options and prognosis, including a consideration of conditions that accompany epilepsy (comorbidities) and complicate the daily lives of people with epilepsy. Subsequent articles in this collection explore the scientific basis of many of the clinical concepts introduced here. DEFINITIONS AND EPIDEMIOLOGYA "seizure" is a paroxysmal alteration of neurologic function caused by the excessive, hyper-

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“…13 The most common cause of seizure relapse in this study was related to irregular drug use with 43.2% which was more than other studies in this area. 16,[21][22] …”

Section: Discussionmentioning

confidence: 99%

Epidemiologic study of causes of seizure attacks in patients admitted to emergency of Zahedan city hospital, 2015-2016

Khosravi¹,

Ghoreishi

Bagheri

2017

Int J Community Med Public Health

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Background: Seizure is one of the most important cause of admission to the emergency department (ED). The admission rate can be decreased by identifying the etiology of seizure which leads to appropriate treatment and elimination of the underlying cause. The purpose of this study is to survey the etiology of seizure in cases admitted to ED. Methods: This cross-sectional study was conducted on 150 patients with seizure admitted to Zahedan city hospital in 2015-16. Data were collected by a checklist including demographic, familial history, past medical history of seizure, cause and type of seizure, time of occurrence, status seizure and cause of recurrence which was completed for each patient. The data was analyzed by statistical methods in SPSS.16. Results: Among all of 150 patients 82 (54.6%) were male and 68 (45.3%) were female. The most common age group was 18-45 years with 114 (76%) patients. 74 (49.3%) patients had PMH of seizure and 15(10%) patients had positive FH of seizure. The most common cause of seizure was idiopathic epilepsy (47.3%), cerebral vascular lesions (14%), withdrawal and poisoning (6.7%). The other causes were paroxysmal non epileptic seizure, primary and secondary brain tumors, metabolic diseases, trauma each with prevalence of (5.3%). Congenital diseases (3.3%), infections (2.7%), demyelinating diseases (2%) and others (2.7%). The most common type of seizures was generalized tonic-colonic seizure (69%). (55.3%) seizures occurred in 6AM- 6PM. (4.6%) patients had status seizure. The most prevalent causes of recurrent seizure was related to inadequate drug use. Conclusions: The most common cause of seizure was idiopathic epilepsy and the next common causes were cerebral vascular lesion and withdrawal. Regular follow up of epileptic patients and eliminating the underlying cause and social abnormality will be effective in decreasing the occurrence of seizure.

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Uncontrolled epilepsy following discontinuation of antiepileptic drugs in seizure-free patients: a review of current clinical experience

Abstract: These serious and substantial risks weigh against discontinuation of AEDs in seizure-free patients, except perhaps for selected patients with idiopathic epilepsy syndromes of childhood or patients with rare seizures.

Cited by 103 publications

References 77 publications

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

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

Seizures and Epilepsy: An Overview for Neuroscientists

Epidemiologic study of causes of seizure attacks in patients admitted to emergency of Zahedan city hospital, 2015-2016

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