Antiepileptic therapy in lesional partial epilepsies: Results of an antiepileptic drug withdrawal study

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

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Abstract

It is debated whether antiepileptic drugs (AEDs) have a "symptomatic" or "curative" effect. We report the results of an AED withdrawal study in 141 patients who were seizure-free for 2-6 years, with cryptogenic (C) or lesional (L) partial epilepsy (PE). Among these patients we distinguished 28 with simple partial seizures (SPS), 41 with complex partial seizures (CPS), 54 with only secondarily generalized seizures (SGS), and 18 with unclassifiable seizures (other). The therapy was reduced by a quarter of the total dose every 3 months. During reduction and after complete suspension patients were followed with clinical, EEC examinations and monitoring of AED blood levels (during reduction) for 5 years. If relapse occurred, patients renewed drugs at the last dose before the relapse, and were followed for at least 2 years. Considering the results of cerebral CT or MRI, neurological examination and aetiology, we distinguished 72 patients with LPE and 69 patients with CPE. Our general results showed an average relapse of 70%. The percentages of relapse differed widely among different types of PE. We found 86% of relapse in SPS, 72% in SGS, 54% in CPS, 78% in other. Considering evidence of a lesion and a family history of epilepsy, we had 79% of relapse in patients with LPE and 57% of relapse in those with CPE (p = 0.028); 48% and 76% of patients, respectively with and without a family history of epilepsy relapsed (p = 0.005). There was no statistical significance related to the type of drug administered before withdrawal or the time elapsing between the onset of seizures and the start of therapy. Our data show that the type of seizures, evidence of lesions and a family history of epilepsy are the most important prognostic risk factors in PE. In particular, the unfavourable prognostic significance linked to the evidence of lesions suggests that pharmacological therapy has only a symptomatic effect in almost all LPE. Otherwise, the lack of relapse in 21% of our patients with LPE suggests that other factors, such as a genetic predisposition to epilepsy, are implicated in the prognosis of PE and that AEDs may have a curative effect in these patients.

Original languageEnglish
Pages (from-to)344
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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