Risk of Recurrence After Anti-Seizure Medication Discontinuation

Yıl 2024, Cilt: 11 Sayı: 2, 62 - 67, 31.08.2024

Firdevs Ezgi Uçan Tokuç , Merve Gürsoy Hasoğlan , Fatma Genç , Meltem Korucuk , Abidin Erdal , Yasemin Biçer Gömceli

https://doi.org/10.47572/muskutd.1482913

Öz

With appropriate anti-seizure medication, long-term seizure freedom can be achieved in about 2/3 of patients with epilepsy. After long-term seizure freedom, the idea of medication discontinuation arises for both patients and physicians. In this study, we aimed to investigate seizure recurrence rates and the factors affecting recurrence in patients whose anti-seizure medication treatment was discontinued. Fifty patients were included in the study. Twenty-eight (56%) patients were female, with a mean age of 41.28±14.58 years and a mean duration of epilepsy of 15.20±9.90 years. Recurrence was observed in 14 (28%) patients. When the recurrence risk factors were analyzed, it was observed that the risk of recurrence decreased as the seizure-free period increased. Our study supports that the risk of relapse after discontinuation of anti-seizure medications decreases as the seizure-free period is prolonged. However, it should not be forgotten that the decision to discontinue medication should be individualized.

Anahtar Kelimeler

Epilepsy, Anti-Seizure Medication Discontinuation, Seizure-Free, Recurrence

Etik Beyan

This study was approved by the human ethics committee of Antalya Training and Research Hospital. 25.04.2024 with protocol code 2024/072.

Destekleyen Kurum

No financial support was received from any institution, organization or person in our study.

Nöbet Önleyici İlaç kesimi Sonrası Rekürrens Riski

Öz

Uygun nöbet önleyici ilaç tedavisi ile epilepsi hastalarının yaklaşık 2/3'ünde nöbetsizlik sağlanabilmektedir. Uzun süreli nöbetsizlikten sonra hem hastalar hem de hekimler için ilaçların kesilmesi fikri ön plana çıkmaktadır. Biz de bu çalışma ile nöbet önleyici ilaç tedavisi kesilen hastalarda nöbet nüks oranlarını ve nüksü etkileyen faktörleri araştırmayı amaçladık. Çalışmaya 50 hasta dahil edildi. Hastaların 28'i (%56) kadındı, yaş ortalaması 41.28±14.58 yıl ve ortalama epilepsi süresi 15.20±9.90 yıldı. Hastaların 14'ünde (%28) nüks gözlendi. Nüks risk faktörleri incelendiğinde, nöbetsizlik süresi arttıkça nüks riskinin azaldığı tespit edildi. Çalışmamız nöbet önleyici ilaçların kesilmesinden sonra nüks riskinin ilaç kesim öncesi nöbetsizlik süresi uzadıkça azaldığını desteklemektedir. Ancak, ilacı bırakma kararının hasta bazında bireyselleştirilmesi gerektiği unutulmamalıdır.

Anahtar Kelimeler

Epilepsi, Nöbet Önleyici İlaç Kesimi, Nöbetsizlik, Nüks

Kaynakça

• 1. Chen Z, Brodie MJ, Liew D, et al. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs a 30-year longitudinal cohort study. JAMA Neurol. 2018;75(3):279–86.
• 2. Alsfouk BAA, Brodie MJ, Walters M, et al. Tolerability of antiseizure medications in individuals with newly diagnosed epilepsy. JAMA Neurol. 2020;77(5):574–581.
• 3. Practice parameter: a guideline for discontinuing antiepileptic drugs in seizure-free patients--summary statement. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1996; 47(2):600–2.
• 4. Randomised study of antiepileptic drug withdrawal in patients in remission. Medical Research Council Antiepileptic Drug Withdrawal Study Group. Lancet. 1991;337(8751):1175-80.
• 5. Camfield P, Camfield C. When is it safe to discontinue AED treatment?. Epilepsia 2008;49(Suppl 9):25–8.
• 6. Beghi E, Giussani G, Grosso S, et al. Withdrawal of antiepileptic drugs: guidelines of the Italian League Against Epilepsy. Epilepsia. 2013;54(suppl 7):2-12.
• 7. Gloss D, Pargeon K, Pack A, et al. Antiseizure medication withdrawal in seizure-free patients: practice advisory update summary. Neurology. 2021;97(23):1072-81.
• 8. Mesraoua B, Perucca E, Tomson T, et al. Should antiseizure medications be withdrawn after an extended period of seizure freedom in individuals with adult-onset epilepsy?. Epilepsy Behav. 2023;142:109205.
• 9. Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475-82.
• 10. Li Y, Chen S, Qin J, et al. Risk of seizure recurrence from antiepileptic drug withdrawal among seizure-free patients for more than two years. Epilepsy Behav. 2020;113:107485.
• 11. Shih JJ, Ochoa JG. A systematic review of antiepileptic drug initiation and withdrawal. Neurologist. 2009;15(3):122–31.
• 12. Balçık ZE, Şenadım E, Söylemez E, et al. Antiepileptik İlaçların Kesilmesi Güvenli midir? Epilepsi: J Turkish Epil Soc. 2020;26(1):35-39.
• 13. Vurucu S, Saldir M, Unay B, et al. Determination of risk factors associated with seizure relapse after antiepileptic drug withdrawal. Cent Eur J Med. 2010;5:251–6.
• 14. Pavlović M, Jović N, Pekmezović T. Antiepileptic drugs withdrawal in patients with idiopathic generalized epilepsy. Seizure. 2011;20(7):520-5.
• 15. Ou S, Xia L, Li R, et al. Long-term outcome of seizure-free patients and risk factors of relapse following antiepileptic drug withdrawal. Epilepsy Behav. 2018;88:295-300.
• 16. Shinnar S, Berg AT, Moshé SL, et al. Discontinuing antiepileptic drugs in children with epilepsy: a prospective study. Ann Neurol. 1994;35(5):534-45.
• 17. Bouma PA, Peters AC, Brouwer OF. Long term course of childhood epilepsy following relapse after antiepileptic drug withdrawal. J Neurol Neurosurg Psychiatry. 2002;72(4):507-10.
• 18. Rizvi S, Ladino LD, Hernandez-Ronquillo L, et al. Epidemiology of early stages of epilepsy: Risk of seizure recurrence after a first seizure. Seizure. 2017;49:46-53.
• 19. Tang L, Xiao Z. Can electroencephalograms provide guidance for the withdrawal of antiepileptic drugs: A meta-analysis. Clin Neurophysiol. 2017;128(2):297-302.
• 20. Afshari D, Moradian N. Evaluating the rate of recurrence of epilepsy after therapy discontinuation in 2-year seizure-free epileptic patients. Int J Neurosci. 2012;122(10):598-601.
• 21. Cardoso TA, Coan AC, Kobayashi E, et al. Hippocampal abnormalities and seizure recurrence after antiepileptic drug withdrawal. Neurology. 2006;67(1):134-6.
• 22. Ramos-Lizana J, Aguirre-Rodríguez J, Aguilera-López P, et al. Recurrence risk after withdrawal of antiepileptic drugs in children with epilepsy: a prospective study. Eur J Paediatr Neurol. 2010;14(2):116-24.
• 23. Benbadis SR, Beniczky S, Bertram E, et al. The role of EEG in patients with suspected epilepsy. Epileptic Disord. 2020;22(2):143-55.
• 24. Overweg J, Binnie CD, Oosting J, et al. Clinical and EEG prediction of seizure recurrence following antiepileptic drug withdrawal. Epilepsy Res. 1987;1(5):272-83.
• 25. Matricardi A, Bertamino F, Risso D. Discontinuation of anti-epileptic therapy: a retrospective study of 86 children and adolescents. Ital J Neurol Sci. 1995;16(9):613-22.
• 26. Schmidt D, Sillanpää M. Stopping epilepsy treatment in seizure remission: Good or bad or both?. Seizure. 2017;44:157-61.
• 27. Chadwick D, Taylor J, Johnson T. Outcomes after seizure recurrence in people with well-controlled epilepsy and the factors that influence it. The MRC antiepileptic drug withdrawal group. Epilepsia. 1996;37(11):1043-50.
• 28. Cho J, Kim H, Chae J, et al. Outcomes of the second withdrawal of anti‐seizure medication in patients with pediatric‐onset epilepsy. Epilepsia, 2023;64(6):e93-7.
• 29. Lossius MI, Alfstad KÅ, Aaberg KM, et al. Discontinuation of antiepileptic drugs in seizure-free patients - when and how?. 2017;137(6):451-4.