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Related Experiment Videos

Remission in epilepsy: How long is enough?

Matti Sillanpää1,2, Dieter Schmidt3, Maiju M Saarinen1,2

  • 1Departments of Child Neurology and Public Health, University of Turku, Turku, Finland.

Epilepsia
|April 5, 2017
PubMed
Summary

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A 5-year remission period, defined as seizure-free for 5 years with 2 years off antiepileptic drugs (AEDs), may be sufficient for predicting low epilepsy relapse risk. This contrasts with the proposed 10-year definition, offering a less stringent yet effective measure for epilepsy remission.

Area of Science:

  • Neurology
  • Epileptology

Background:

  • The International League Against Epilepsy (ILAE) proposed extending the epilepsy remission definition to 10 years seizure-free, including the last 5 years off antiepileptic drugs (AEDs).
  • This study investigates whether a 10-year remission is necessary to accurately predict the lowest risk of epilepsy recurrence.

Purpose of the Study:

  • To evaluate the predictive value of different remission durations (2, 5, and 10 years seizure-free, with varying periods off AEDs) on epilepsy relapse risk.
  • To determine if the proposed 10-year ILAE remission definition is optimal for identifying patients with minimal recurrence risk.

Main Methods:

  • A population-based cohort of 148 patients with new-onset childhood epilepsy was prospectively followed for a median of 44 years.
  • Patients in remission were assessed at 2, 5, and 10 years seizure-free, with specific off-AED periods (1, 2, and 5 years, respectively).
Keywords:
Length of remissionLong-term follow-upPopulation studyRemitted epilepsyRisk of relapse

Related Experiment Videos

  • Exact Clopper-Pearson 95% confidence intervals were used to compare relapse proportions across remission categories.

    • Main Results:

    • Relapse rate estimates off AEDs did not significantly improve with extended remission from 2 to 5 and 10 years.
    • The ability to predict a lower relapse rate increased significantly from 2 to 5 years, and again from 5 to 10 years off AEDs.
    • The risk of relapse after 2 years off AEDs was similar to that after 10 years off AEDs, except in generalized epilepsy.

    Conclusions:

    • The modest differences in relapse rates between 5-year (2 years off AEDs) and 10-year (5 years off AEDs) remission definitions suggest the latter may not be essential.
    • Considering the adverse impact of prolonged remission criteria, a return to the 5-year definition is proposed.
    • A 5-year seizure-free period with 2 years off AEDs may be a more practical and effective definition for epilepsy remission.