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. 2002 Jan;72(1):22–25. doi: 10.1136/jnnp.72.1.22

Discontinuing antiepileptic drugs in patients who are seizure free on monotherapy

L Specchio 1, L Tramacere 1, A La Neve 1, E Beghi 1
PMCID: PMC1737684  PMID: 11784819

Abstract

Objectives: To assess the recurrence rate of epilepsy attributable to discontinuation of treatment in seizure free patients and to identify the risk factors for recurrence.

Methods: 330 patients referred to an epilepsy centre who were seizure free for at least 2 years while on stable monotherapy were the study population. Discontinuation of antiepileptic drugs (AEDs) was proposed to all eligible patients or to their carers after discussion of the risks and benefits. Depending on whether they accepted or refused treatment withdrawal, the patients were stratified into two cohorts and followed up until seizure relapse or 31 March 1999, whichever came first. For each patient, records were taken of the main demographic and clinical variables.

Results: The sample comprised 225 patients who entered the discontinuation programme and 105 who decided to continue treatment. Twenty nine patients (28%) continuing treatment had a relapse, compared with 113 (50%) of those entering the withdrawal programme. For patients continuing treatment, the probability of remission was 95% at 6 months, 91% at 12 months, 82% at 24 months, 80% at 36 months, and 68% at 60 months. The corresponding values for patients discontinuing treatment were 88%, 74%, 57%, 51%, and 48%. After adjusting for the principal prognostic factors, in patients discontinuing AEDs the risk of seizure relapse was 2.9 times that of patients continuing treatment. A relation was also found between relapse and duration of active disease, number of years of remission while on treatment, and abnormal psychiatric findings.

Conclusions: Seizure free referral patients on stable monotherapy who elect to withdraw drug treatment are at higher risk of seizure relapse compared with patients continuing treatment. Severity of disease and seizure free period are significant prognostic factors.

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Selected References

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  1. Andersson T., Braathen G., Persson A., Theorell K. A comparison between one and three years of treatment in uncomplicated childhood epilepsy: a prospective study. II. The EEG as predictor of outcome after withdrawal of treatment. Epilepsia. 1997 Feb;38(2):225–232. doi: 10.1111/j.1528-1157.1997.tb01101.x. [DOI] [PubMed] [Google Scholar]
  2. Arts W. F., Visser L. H., Loonen M. C., Tjiam A. T., Stroink H., Stuurman P. M., Poortvliet D. C. Follow-up of 146 children with epilepsy after withdrawal of antiepileptic therapy. Epilepsia. 1988 May-Jun;29(3):244–250. doi: 10.1111/j.1528-1157.1988.tb03713.x. [DOI] [PubMed] [Google Scholar]
  3. Berg A. T., Shinnar S. Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology. 1994 Apr;44(4):601–608. doi: 10.1212/wnl.44.4.601. [DOI] [PubMed] [Google Scholar]
  4. Bouma P. A., Peters A. C., Arts R. J., Stijnen T., Van Rossum J. Discontinuation of antiepileptic therapy: a prospective study in children. J Neurol Neurosurg Psychiatry. 1987 Dec;50(12):1579–1583. doi: 10.1136/jnnp.50.12.1579. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Braathen G., Melander H. Early discontinuation of treatment in children with uncomplicated epilepsy: a prospective study with a model for prediction of outcome. Epilepsia. 1997 May;38(5):561–569. doi: 10.1111/j.1528-1157.1997.tb01141.x. [DOI] [PubMed] [Google Scholar]
  6. Callaghan N., Garrett A., Goggin T. Withdrawal of anticonvulsant drugs in patients free of seizures for two years. A prospective study. N Engl J Med. 1988 Apr 14;318(15):942–946. doi: 10.1056/NEJM198804143181502. [DOI] [PubMed] [Google Scholar]
  7. 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 Nov;37(11):1043–1050. doi: 10.1111/j.1528-1157.1996.tb01023.x. [DOI] [PubMed] [Google Scholar]
  8. Dooley J., Gordon K., Camfield P., Camfield C., Smith E. Discontinuation of anticonvulsant therapy in children free of seizures for 1 year: a prospective study. Neurology. 1996 Apr;46(4):969–974. doi: 10.1212/wnl.46.4.969. [DOI] [PubMed] [Google Scholar]
  9. Emerson R., D'Souza B. J., Vining E. P., Holden K. R., Mellits E. D., Freeman J. M. Stopping medication in children with epilepsy: predictors of outcome. N Engl J Med. 1981 May 7;304(19):1125–1129. doi: 10.1056/NEJM198105073041902. [DOI] [PubMed] [Google Scholar]
  10. JUUL-JENSEN P. FREQUENCY OF RECURRENCE AFTER DISCONTINUANCE OF ANTI-CONVULSANT THERAPY IN PATIENTS WITH EPILEPTIC SEIZURES. Epilepsia. 1964 Dec;5:352–363. doi: 10.1111/j.1528-1157.1964.tb03341.x. [DOI] [PubMed] [Google Scholar]
  11. Matricardi M., Brinciotti M., Benedetti P. Outcome after discontinuation of antiepileptic drug therapy in children with epilepsy. Epilepsia. 1989 Sep-Oct;30(5):582–589. doi: 10.1111/j.1528-1157.1989.tb05476.x. [DOI] [PubMed] [Google Scholar]
  12. Nalin A., Galli V., Ferrari P., Ciccarone V. Sospensione della terapia antiepilettica in soggetti con epilessia insorta nell'età infantile. Pediatr Med Chir. 1982 Nov-Dec;4(6):601–605. [PubMed] [Google Scholar]
  13. Oller-Daurella L., Marquez J. Survey of 100 epileptics who have not had seizures for ten years or more. Epilepsia. 1972 Jan;13(1):161–170. doi: 10.1111/j.1528-1157.1972.tb04563.x. [DOI] [PubMed] [Google Scholar]
  14. Oller-Daurella L., Oller L. F. Influence of the 'lost time' on the outcome of epilepsy. Eur Neurol. 1991;31(3):175–177. doi: 10.1159/000116672. [DOI] [PubMed] [Google Scholar]
  15. Oller-Daurella L., Oller L. Suppression of antiepileptic treatment. Eur Neurol. 1987;27(2):106–113. doi: 10.1159/000116141. [DOI] [PubMed] [Google Scholar]
  16. Peto R., Pike M. C., Armitage P., Breslow N. E., Cox D. R., Howard S. V., Mantel N., McPherson K., Peto J., Smith P. G. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977 Jan;35(1):1–39. doi: 10.1038/bjc.1977.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Sander J. W. Some aspects of prognosis in the epilepsies: a review. Epilepsia. 1993 Nov-Dec;34(6):1007–1016. doi: 10.1111/j.1528-1157.1993.tb02126.x. [DOI] [PubMed] [Google Scholar]
  18. Shinnar S., Berg A. T., Moshé S. L., Kang H., O'Dell C., Alemany M., Goldensohn E. S., Hauser W. A. Discontinuing antiepileptic drugs in children with epilepsy: a prospective study. Ann Neurol. 1994 May;35(5):534–545. doi: 10.1002/ana.410350506. [DOI] [PubMed] [Google Scholar]
  19. Shinnar S., Vining E. P., Mellits E. D., D'Souza B. J., Holden K., Baumgardner R. A., Freeman J. M. Discontinuing antiepileptic medication in children with epilepsy after two years without seizures. A prospective study. N Engl J Med. 1985 Oct 17;313(16):976–980. doi: 10.1056/NEJM198510173131603. [DOI] [PubMed] [Google Scholar]
  20. Tennison M., Greenwood R., Lewis D., Thorn M. Discontinuing antiepileptic drugs in children with epilepsy. A comparison of a six-week and a nine-month taper period. N Engl J Med. 1994 May 19;330(20):1407–1410. doi: 10.1056/NEJM199405193302002. [DOI] [PubMed] [Google Scholar]
  21. Thurston J. H., Thurston D. L., Hixon B. B., Keller A. J. Prognosis in childhood epilepsy: additional follow-up of 148 children 15 to 23 years after withdrawal of anticonvulsant therapy. N Engl J Med. 1982 Apr 8;306(14):831–836. doi: 10.1056/NEJM198204083061403. [DOI] [PubMed] [Google Scholar]
  22. Tinuper P., Avoni P., Riva R., Provini F., Lugaresi E., Baruzzi A. The prognostic value of the electroencephalogram in antiepileptic drug withdrawal in partial epilepsies. Neurology. 1996 Jul;47(1):76–78. doi: 10.1212/wnl.47.1.76. [DOI] [PubMed] [Google Scholar]
  23. Todt H. The late prognosis of epilepsy in childhood: results of a prospective follow-up study. Epilepsia. 1984 Apr;25(2):137–144. doi: 10.1111/j.1528-1157.1984.tb04169.x. [DOI] [PubMed] [Google Scholar]

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