Prognosis of seizure recurrence after stopping antiepileptic drugs in seizure-free patients: A long-term population-based study of childhood-onset epilepsy

Epilepsy & Behavior : E&B
M Sillanpää, D Schmidt

Abstract

The long-term outcome with respect to seizure relapse after planned discontinuation of antiepileptic drugs (AEDs) in seizure-free patients is not well known. Relapse and its treatment outcome were evaluated in a longitudinal population-based study of 148 patients from the onset of their epilepsy to an average follow-up of 37 years. During the study, AEDs were completely discontinued by 90 patients; 58 patients remained on medication. Seizure relapse after AED discontinuation was observed in 33 (37%) of 90 patients at an average follow-up of 32 years. Among 8 of the 33 patients who elected to restart AEDs, 2 achieved 5-year terminal remission (5YTR), but only 10-19 years after restarting treatment. The other 6 patients never achieved 5YTR, and 2 of the 6 never entered a 5-year remission period during follow-up. Factors associated with failure to reach 5YTR after treatment of relapse were symptomatic etiology and localization-related epilepsy. In conclusion, drug discontinuation after seizure freedom results in relapse in one-third of patients. Reinstitution of a medication that worked for years fails to achieve control in one of four patients. These risks need to be considered, although there is no evidence that discontinuation ...Continue Reading

References

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Sep 3, 2002·Annals of Neurology·Matti Sillanpää, Shlomo Shinnar
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Jun 11, 2005·Epilepsia·Dieter Schmidt, Wolfgang Löscher

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Citations

Dec 17, 2014·Lancet Neurology·Dieter Schmidt
Feb 18, 2014·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Wei LiDong Zhou
Dec 17, 2010·Journal of Neural Transmission·Ettore Beghi
Dec 18, 2010·Journal of Neural Transmission·Dieter Schmidt
Feb 28, 2007·Nature Clinical Practice. Neurology·Emilio Perucca
Aug 24, 2010·Current Treatment Options in Neurology·John D Hixson
Jul 1, 2014·Epilepsy & Behavior : E&B·Matti SillanpääDieter Schmidt
Jul 31, 2012·Lancet Neurology·Dieter Schmidt
Mar 9, 2012·European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society·A VerrottiG Coppola
Nov 9, 2011·Seminars in Pediatric Neurology·Sarah A Kelley, Adam L Hartman
Feb 25, 2009·Epilepsy & Behavior : E&B·Dieter Schmidt
Apr 28, 2007·CNS Drug Reviews·Tim De SmedtPaul Boon
Apr 16, 2014·Epilepsia·Allen Hauser
Apr 8, 2016·Expert Review of Neurotherapeutics·Stefano StagiAlberto Verrotti
Apr 28, 2007·Seizure : the Journal of the British Epilepsy Association·Rianne P ReijsAlbert P Aldenkamp
May 4, 2011·Epilepsy Research·Lila T WordenEric H Kossoff
Jan 28, 2015·Nature Reviews. Neurology·Matti Sillanpää, Dieter Schmidt
Nov 9, 2011·Seminars in Pediatric Neurology·Eric H Kossoff
Oct 11, 2016·Seizure : the Journal of the British Epilepsy Association·Dieter Schmidt, Matti Sillanpää
Sep 21, 2016·Seizure : the Journal of the British Epilepsy Association·M Sillanpää, D Schmidt
Apr 5, 2017·Epilepsia·Matti SillanpääShlomo Shinnar
Jan 15, 2017·Pediatrics and Neonatology·Inn-Chi LeeYung-Jung Chen
Dec 13, 2016·Seizure : the Journal of the British Epilepsy Association·Christina E Hoei-HansenPeter Uldall
Apr 30, 2015·The Cochrane Database of Systematic Reviews·Isabella StrozziJoseph Sirven
Jan 13, 2018·Current Opinion in Neurology·Steven C Schachter
Oct 17, 2019·Acta Neurologica Scandinavica·Sachin KumarYogendra Kumar Gupta
Feb 22, 2014·Current Opinion in Neurology·Kees P J Braun, Dieter Schmidt
May 12, 2009·The Neurologist·Jerry J Shih, Juan G Ochoa
Jun 10, 2020·Expert Review of Neurotherapeutics·Sara MatricardiAlberto Verrotti
Mar 31, 2021·Brain & Development·Nicola PietrafusaNicola Specchio

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