Predicting Seizure Recurrence Risk after Discontinuation of Antiepileptic Drugs
Discontinuation of antiepileptic
drugs (AEDs) in seizure-free patients is an important goal because of possible
long-term side effects and the social stigma burden of epilepsy.
The purpose of this study was to
assess seizure recurrence risk after suspension of AEDs, to evaluate predictors
for recurrence, and to investigate the recovery of seizure control after
relapse. In addition, the accuracy of a previously published prediction model
of seizure recurrence risk was estimated.
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Seizure relapses and possible
predictors of recurrence were evaluated in 133 patients followed for a median
of 3 years after AED withdrawal.
A period of freedom from seizure on
therapy of less than 2 years was the main predictor of seizure recurrence.
For the patients who had a seizure
recurrence, the event occurred within the first year from the beginning of
tapering in 68.3% and within 2 years in 86.7%.
In those who relapsed, almost
four-fifths became seizure-free again with medication, with most regaining
seizure control within the first year from recurrence
About 82% of patients regained
seizure control after relapse but no predictor of the recovery could be
identified.
While there were some hints that
the presence of persistent motor deficits and a history of febrile seizures in
childhood may be associated with a higher rate of relapse, in the multivariate
analysis only a seizure-free period of less than 2 years while on therapy was
associated with seizure recurrence as a risk factor.
The accuracy of the Lamberink
prediction model was low in this cohort suggesting its cautious use in
real-world clinical practice.
This analysis provides insight on a critical clinical question concerning epilepsy patients who have had a seizure-free period and for whom discontinuation of ASMs is being considered.
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OBJECTIVE
Discontinuation of antiepileptic
drugs (AEDs) in seizure-free patients is an important goal because of possible
long-term side effects and the social stigma burden of epilepsy. The purpose of
this work was to assess seizure recurrence risk after suspension of AEDs, to
evaluate predictors for recurrence, and to investigate the recovery of seizure
control after relapse. In addition, the accuracy of a previously published
prediction model of seizure recurrence risk was estimated.
METHODS
Seizure-free patients with epilepsy
who had discontinued AEDs were retrospectively enrolled. The frequency of
seizure relapses after AED withdrawal as well as prognosis after recurrence was
assessed and the predictive role of baseline clinical-demographic variables was
evaluated. The aforementioned prediction model was also validated and its
accuracy assessed at different seizure-relapse probability levels.
RESULTS
The enrolled patients
(n = 133) had been followed for a median of 3 years (range 0.8-33
years) after AED discontinuation; 60 (45%) of them relapsed. Previous febrile
seizures in childhood, a seizure-free period on therapy of less than 2 years,
and persistent motor deficits were the clinical features associated with
relapse risk in univariate analysis. Among these variables, only a seizure-free
period on therapy of less than 2 years was associated with seizure recurrence
in multivariate analysis. Pharmacological control of epilepsy was restored in
82.4% of the patients who relapsed. In this population, the aforementioned
prediction model showed an unsatisfactory accuracy.
SIGNIFICANCE
A period of freedom from seizure on therapy of less than 2 years was the main predictor of seizure recurrence. The accuracy of the previously described prediction tool was low in this cohort, thus suggesting its cautious use in real-world clinical practice.
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