Discontinuation and duration of antiepileptic drug therapy: a retrospective study of factors for specific epileptic syndromes.
OBJECTIVE
To study factors associated with discontinuation of antiepileptic drugs (AEDs) in idiopathic generalized epilepsy (IGE) and symptomatic/cryptogenic localization-related epilepsy (S/CLRE) METHODS: For the IGE study, 71 patients who were able to discontinue their AED (discontinued-IGE group) were compared to 71 patients who continued AED therapy (continued-IGE group) and 20 patients with seizure relapse after discontinuing AED (relapsed-IGE group). For S/CLRE, 90 patients who were able to discontinue AED (discontinued-S/CLRE group) were compared to 90 patients who continued AED (continued-S/CLRE group) and 76 patients with benign childhood epilepsy with centrotemporal spikes who were able to discontinue AED (discontinued-BECTS group).


RESULTS
Compared to the continued-IGE group, the discontinued-IGE group showed a weaker seizure propensity, better response to AEDs, more frequent epileptiform discharge suppression, and lower frequency of generalized tonic-clonic seizures (GTCs). Compared to the relapse-IGE group, the discontinued-IGE group had more frequent epileptiform discharge suppression. The discontinued-S/CLRE group showed a weaker seizure propensity, better response to AEDs, more frequent epileptiform discharge suppression, and less frequent symptomatic signs compared to the continued-S/C LRE group. Notably, the age at epilepsy onset was not a critical factor for discontinuing AEDs in both IGE and S/CLRE. Although the discontinued-S/CLRE group had more frequent symptomatic signs, older age at epilepsy onset and less frequent epileptiform discharge suppression than the discontinued-BECTS group, no difference was found in seizure propensity and response to AEDs between the two groups.


CONCLUSIONS
Seizure propensity, epileptiform discharge, and response to AEDs should be considered to predict the possibility of terminating AED therapy in IGE or S/CLRE. In addition, attention should be paid to seizure pattern in IGE and symptomatic signs in LRE.
Kudo
Tatsuya
T
National Epilepsy Center, Shizuoka Medical Institute of Neurological Disorders, Shizuoka, Japan. tatsuya@szec.hosp.go.jp
Nishida
Takuji
T
Yagi
Kazuichi
K
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004828:Epilepsies, Partial / Q000188:drug therapy*; D004829:Epilepsy, Generalized / Q000188:drug therapy*; D019305:Epilepsy, Rolandic / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D010352:Patient Dropouts / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
D000927:Anticonvulsants