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Published on: May 16, 2019
Antiepileptic drugs withdrawal in patients with idiopathic generalized epilepsy
Milen Pavlović1, Nebojša Jović, Tatjana Pekmezović
1Institute of Child and Youth Health Care of Vojvodina, Hajduk Veljkova 10, Novi Sad, Serbia. milen_p@ptt.rs
Insights
Seizure recurrence risk after antiepileptic drug (AED) withdrawal is high in idiopathic generalized epilepsy (IGE), especially for juvenile myoclonic epilepsy (JME). Seizure type and EEG worsening are key predictors of relapse.
Area of Science:
- Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Idiopathic generalized epilepsy (IGE) often begins in childhood or adolescence.
- Antiepileptic drug (AED) withdrawal is a common consideration in managing epilepsy.
- Predicting seizure recurrence after AED withdrawal is crucial for patient management.
Purpose of the Study:
- To determine the risk of seizure recurrence following antiepileptic drug (AED) withdrawal in patients with idiopathic generalized epilepsy (IGE) diagnosed in childhood or adolescence.
- To identify factors that predict seizure relapse after AED withdrawal in this specific patient population.
Main Methods:
- A retrospective review of medical records from 59 patients with IGE diagnosed between 2001 and 2009 was conducted.
- Patients had a minimum of 2 years follow-up after AED withdrawal.
- Survival analysis methods were used to analyze time to seizure relapse and predictive factors.
Main Results:
- Overall, 52.2% of patients experienced seizure relapse after AED withdrawal.
- Relapse rates varied significantly by IGE syndrome, with the highest in juvenile myoclonic epilepsy (JME) and lowest in childhood absence epilepsy (CAE).
- Multivariate analysis identified seizure type and electroencephalogram (EEG) worsening during or after AED withdrawal as independent predictors of relapse.
Conclusions:
- The specific type of idiopathic generalized epilepsy (IGE) syndrome significantly influences the rate of seizure recurrence after antiepileptic drug (AED) withdrawal.
- Seizure type and electroencephalogram (EEG) worsening are critical independent risk factors for predicting seizure relapse in patients with IGE following AED withdrawal.
Objectives:
To estimate the risk of seizure recurrence after antiepileptic drugs (AED) withdrawal and to identify related predictive features in patients with idiopathic generalized epilepsy (IGE) commencing at developing age (up to 16 year).
Methods:
Medical records of consecutive patients with IGE from two refferal hospitals were evaluated between 2001 and 2009. Inclusion criteria were clinical and EEG diagnosis of IGE and follow up for at least 2years after the AED withdrawal. The cohort consisted of 59 patients (38 females, 21 males). Follow up after withdrawal lasted 2-10years (median 3) Time to seizure relapse and predictive factors were analyzed by survival methods.
Results:
There were 21 (35.6%) patients with childhood absence epilepsy (CAE), 11 (18.6%) with juvenile absence epilepsy (JAE), 10 (16.9%) with isolated primary GTC seizures, and 17 (28.8%) with juvenile myoclonic epilepsy (JME). The relapses occured in 23 (52.2%) patients: one (6.2%) with CAE, 4 (50%) with JAE, 8 (80%) with IGE with GTC seizures and all with JME. During the first 6 months 54.5% patients relapsed (20% during withdrawal), 63.6% within 12 months, 81.8% within18 months and 95.4% within 24 months after withdrawal. Female gender, age at onset of seizures, seizure types, EEG worsening during/after AED withdrawal and age at withdrawal were significantly associated with relapse risk according to univariate analysis. In multivariate analysis, retained significant factors were: seizure types and EEG worsening.
Conclusion:
Diagnosis of the specific IGE syndrome strongly affects relapse rate: the lowest was in CAE, the highest in JME. Independent risk factors for seizure relapse were: seizure type and EEG worsening during and/or after withdrawal.
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