Withdrawal of Anticonvulsant Drugs in Patients Free of Seizures for Two Years

Abstract

We discontinued anticonvulsant drugs in 92 patients who had been free of seizures during two years of treatment with a single drug. All the patients had epilepsy that had previously been untreated, and had been randomly assigned to receive carbamazepine, phenytoin, or sodium valproate. Thirty-one patients relapsed, and 61 remained free of seizures. The mean duration of the follow-up in the patients remaining free of seizures was 35 months (range, 6 to 62). There was no significant difference between the relapse rate among adults (35 percent) and that among children (31 percent). Our results suggest that the number of seizures a patient had before control was achieved, the number of drugs tried as single-drug therapy, and the type of treatment withdrawn all influenced the outcome. Among the various types of seizures, complex partial seizures with secondary generalization carried the worst prognosis. In comparison, the risk of relapse was 65 percent lower in patients with generalized seizures and 97 percent lower in patients with complex or simple partial seizures in the absence of secondary generalized attacks. Among the four electroencephalographic classes, class 4 (abnormal before treatment and unchanged before withdrawal) carried the worst prognosis. The risk of relapse was 94 to 99 percent lower in patients in the other three electroencephalographic classes. Among the three anticonvulsants, withdrawal of sodium valproate carried the worst prognosis. In comparison, the odds of relapsing were 28 percent lower after withdrawal of phenytoin and 85 percent lower after withdrawal of carbamazepine. We conclude that withdrawal of anticonvulsant medication should be considered in patients free of seizures for two years.

Is low antiepileptic drug dose effective in long-term seizure-free patients?

“…That is because there is a co-linearity between them. This variable, which is an indicator of seizure severity before control, has been shown by other studies to be a predictive factor for seizure recurrence after AED withdrawal [19][20][21] . Other studies have demonstrated that this factor has shown only a tendency towards significance 22,23 .…”

Early withdrawal of non-anesthetic antiepileptic drugs after successful termination of nonconvulsive seizures and nonconvulsive status epilepticus

“…While some studies show that within the NCS/NCSE group, subjects with generalized ictal discharges had a worse prognosis compared to subjects with unilateral ictal discharges [34], others did not find any prognostic correlation with abnormal or epileptiform EEG [31]. In the context of AED withdrawal, a number of studies have identified factors associated with increased risk of relapse including multiple seizure types, focal epileptiform abnormalities on EEG, and worsening EEG patterns after AED discontinuation [29,[35][36][37]. While we did not analyze outcomes based on NCS/NCSE subtypes, we did find that the primary background EEG abnormality was similar to previously published studies and did not differ between the wean and non-wean groups.…”

Transtornos mentais associados à epilepsia

“…Aproximadamente dois terços das pessoas que obtiveram controle podem interromper o tratamento com DAE após período aproximado de dois anos, continuando em remissão posteriormente (Sander, 1993;Callaghan et al, 1988;Medical Research Council Antiepileptic Drug Withdrawal Study Group, 1991).…”