title: Risk of seizure relapse after antiepileptic drug withdrawal in adult patients with focal epilepsy.
abstract: The objective of this study was to estimate the risk of a seizure relapse and the high-risk period of recurrence after antiepileptic drug (AED) withdrawal and to determine the predictive factors for a seizure relapse in adult patients with focal epilepsy who were seizure-free for more than 2years.
  
  
  
  Using the Wenzhou Epilepsy Follow-Up Registry Database, 200 adult patients with focal epilepsy were recruited, who were undergoing follow-up, met the inclusion criteria of this study, were seizure-free for more than 2years, began withdrawing between June 2003 and June 2014, and were followed up prospectively for at least 1year or until a seizure relapse. The risk of recurrence and the time to seizure relapse were analyzed by the Kaplan-Meier method, and the predictive factors were identified by the Cox proportional hazard regression model.
  
  
  
  A total of 99 patients had an unprovoked relapse during the follow-up period. The relapse rate was 49.5%, and each year, the recurrence probability of 12, 24, 36, 48, 60, 72, and 84months after AED withdrawal was 24.0%, 20.4%, 8.3%, 2.7%, 4.6%, 0.97%, and 0.98%, respectively. The two independent risk factors for recurrence after withdrawal in adult patients with focal epilepsy were a longer duration of active epilepsy and a shorter seizure-free period before withdrawal.
  
  
  
  The high-risk period of a seizure relapse in adult patients with focal epilepsy is the first 2years after withdrawal, and beyond 5years after withdrawal, seizures rarely relapse (relapse rate<1%). A seizure-free period for less than 4years before withdrawal is a predictive factor of risk for seizure recurrence after AED withdrawal in adult patients with focal epilepsy.
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Street, Ouhai District, Wenzhou City, Zhejiang Province 325015, PR China; Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University (Ruian People's Hospital), Wansong Street, Ruian District, Wenzhou City, Zhejiang Province 325200, PR China.
authors.forename: Ru-Qian
authors.initials: RQ
authors.lastname: He
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Street, Ouhai District, Wenzhou City, Zhejiang Province 325015, PR China.
authors.forename: Qing-Yi
authors.initials: QY
authors.lastname: Zeng
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Street, Ouhai District, Wenzhou City, Zhejiang Province 325015, PR China.
authors.forename: Pan
authors.initials: P
authors.lastname: Zhu
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Street, Ouhai District, Wenzhou City, Zhejiang Province 325015, PR China.
authors.forename: Yi-Xin
authors.initials: YX
authors.lastname: Bao
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Street, Ouhai District, Wenzhou City, Zhejiang Province 325015, PR China. Electronic address: zhengry2013@163.com.
authors.forename: Rong-Yuan
authors.initials: RY
authors.lastname: Zheng
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Street, Ouhai District, Wenzhou City, Zhejiang Province 325015, PR China. Electronic address: xuhuiqin1972@163.com.
authors.forename: Hui-Qin
authors.initials: HQ
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D004828:Epilepsies, Partial / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D012640:Seizures / Q000188:drug therapy*; D013997:Time Factors; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Adult; Focal epilepsy; Risk factor; Seizure relapse; Withdrawal