title: Prospective study on the withdrawal and reinstitution of antiepileptic drugs among seizure-free patients in west China.
abstract: This study explored the relapse rates and risk factors for seizure recurrence after discontinuing antiepileptic drug (AED) therapy among seizure-free patients in west China, and explored whether to reinstitute AED immediately after a single seizure after AED withdrawal. Patients with epilepsy who were seizure-free for at least 2 years and decided to gradually stop AED therapy were followed up every 3 months for seizure relapse. Patients who experienced their first seizure after drug withdrawal were divided into two groups according to their willingness to reinstitute AED therapy, and were followed up until their second seizure. In the mean 29.35 months of follow-up, 37 patients (37/162, 22.8%) suffered at least one seizure after withdrawal. The cumulative probability of seizure recurrence was 16% at 12 months and 20.2% at 24 months. AED response time >1 year and multiple types of seizure were identified as risk factors for seizure recurrence. Eight patients (8/32, 25%) suffered a second seizure within 1 year after the first whether or not they reinstituted AED immediately. There were no significant demographic or clinical differences between patients who reinstituted AED therapy and those who did not. The epilepsy recurrence rate after AED withdrawal is relatively low, with a relatively slow tapering process. Patients with long AED response times and/or multiple types of seizures have a higher risk of seizure recurrence. The first seizure after drug withdrawal is not an indication for immediate AED reinstitution, but may be recommended after a second seizure.
authors: Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Department of Neurosurgery, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors: Wei
authors: W
authors: Li
authors: Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
authors: Yang
authors: Y
authors: Si
authors: Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
authors: Xue-mei
authors: XM
authors: Zou
authors: Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
authors: Dong-mei
authors: DM
authors: An
authors: Department of Neurosurgery, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors: Hui
authors: H
authors: Yang
authors: Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China. Electronic address: zhoudong66@yahoo.de.
authors: Dong
authors: D
authors: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Antiepileptic drugs; Epilepsy; Recurrence; Reinstitution; Risk factor; Withdrawal