Antiepileptic drug withdrawal: When to risk

P. Avoni, R. Riva, P. Tinuper, A. Cerullo, A. Baruzzi

Research output: Contribution to journalArticle

Abstract

The evolution of epilepsies is still debated. We performed an antiepileptic drug (AED) withdrawal study in 231 adult patients seizure-free for 2 to 6 years. Our aims were to investigate the prognosis of epilepsies and to define the importance of single risk factors in each type of epilepsy. Among generalized epilepsies (GE) we distinguished 39 patients with idiopathic grand mal (IGM), 18 with juvenile absence epilepsy (JAE) and 17 with juvenile myoclonic epilepsy (JME); among partial epilepsies (PE) we selected 28 patients with simple partial seizures (SPS), 41 patients with complex partial seizures (CPS) and 54 with only secondarily generalized seizures (SGS). Moreover, we identified 16 patients with unclassifiable GE and 18 with unclassifiable PE (other). Our general data showed 64% and 72% of relapse, respectively, in patients followed for 3 and 5 years after complete AED suspension. Considering the group with a follow-up of 3 years (in parentheses the percentages of patients with a follow-up of 5 years), relapse occurred in 54% (59%) of IGM, 72% (78%) of JAE, 82% (82%) of JME, 87% ( 100%) of other GE, 75% (86%) of SPS, 46% (54%) of CPS, 63% (72%) of SGS and 67% (72%) of other PE. A favourable prognostic significance (in parentheses the percentages of relapse) was found in the case of IGM for age at withdrawal over 30 years (0% vs. 40%) and a frequency of seizures under I/year (35% vs. 75%); in the case of JAE the age at onset of seizures under 10 years (40% vs. 85%) and an active phase of disease lasting less than 2 years (25% vs. 86% ); in the case of CPS for a family history of epilepsy (20% vs. 55%). a lack of cerebral lesions (0% vs. 62% ) and an active phase of disease lasting less than 1 year (26% vs. 64%); in the case of SGS for the lack of EEG worsening during and after AED withdrawal (47% vs. 90%). In conclusion, the prognosis differs widely among different types of epilepsy. Some forms relapse to a greater extent and require continuous AED treatment. Other forms relapse in different percentages and for these some specific factors can help define the risk of relapse.

Original languageEnglish
Pages (from-to)358
Number of pages1
JournalItalian Journal of Neurological Sciences
Volume20
Issue number5
Publication statusPublished - 1999

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ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology

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