title: Effect of reduction of antiepileptic drugs in patients with drug-refractory epilepsy.
abstract: OBJECTIVE
  The present study was conducted with the aim of evaluating the effects of reducing the number of antiepileptic drugs (AEDs) administered to patients with drug-refractory epilepsy (DRE) during their admission and document any change in seizure frequency in subsequent follow up.
  
  
  METHODS
  A total of 962 patients with DRE who were admitted to the neurology wards waiting for connection to video EEG were recruited for this prospective study. After their admission to the neurology ward, modifications in the number and dosage of AEDs were done with a target of a maximum of three AEDs in every patient. Drug tapering was done using a standardized protocol. The primary outcome was the change in seizure frequency in the follow-up period of 6 months. Secondary outcome measures were the adverse event profile (AEP) and the quality of life (QOL).
  
  
  RESULTS
  Of the 1134 patients screened, 962 patients gave consent to participate in the study. The mean number of AEDs received by each patient was 4.24. After the tapering following a standardized protocol each patient received a mean of 2.65 AEDs per patient. In 82.70% patients with DRE, there was either a reduction or no change in seizure frequency in the subsequent 6 months follow up. There was a significant reduction in the AEP score after the reduction in the number of AEDs (P = 0. 001).
  
  
  CONCLUSIONS
  Our study proves that optimization of reduction of the number of AED's in patients with DRE leads to reduction or no change in seizure frequency with a significant decrease in adverse effects.
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Deepa
authors.initials: D
authors.lastname: Dash
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Aggarwal
authors.affiliation: Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Rupa
authors.initials: R
authors.lastname: Joshi
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Madakasira Vasantha
authors.initials: MV
authors.lastname: Padma
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: manjari.tripathi1@gmail.com.
authors.forename: Manjari
authors.initials: M
authors.lastname: Tripathi
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects / Q000145:classification; D002648:Child; D002675:Child, Preschool; D000069279:Drug Resistant Epilepsy / Q000188:drug therapy*; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic; D011788:Quality of Life; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Antiepileptic drugs; Drug refractory epilepsy; Epilepsy monitoring unit; Reduction