Stopping antiepileptic drugs: When and why?

Current Treatment Options in Neurology

Volumn 12, Issue 5, 2010, Pages 434-442

  Hixson, John D ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTICONVULSIVE AGENT;

ATTENTION DISTURBANCE; CLINICAL PRACTICE; CLINICAL TRIAL; DISEASE DURATION; DROWSINESS; DRUG DOSE REDUCTION; DRUG INDICATION; ELECTROENCEPHALOGRAPHY; EPILEPSY; FATIGUE; HUMAN; PATIENT ATTITUDE; PATIENT COUNSELING; PATIENT DECISION MAKING; PATIENT SAFETY; PROGNOSIS; QUALITY OF LIFE; RECURRENT DISEASE; REMISSION; REVIEW; RISK ASSESSMENT; RISK BENEFIT ANALYSIS; TREATMENT WITHDRAWAL;

EID: 78149466589     PISSN: 10928480     EISSN: None     Source Type: Journal    
DOI: 10.1007/s11940-010-0083-8     Document Type: Review

References (48)

1. Berg AT, Shinnar S: The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology 1991, 41:965-972.
2. First Seizure Trial Group: Randomized clinical trial of the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. Neurology 1993, 43:478-483.
3. Hauser WA, Rich SS, Lee JR, et al.: Risk of recurrent seizures after two unprovoked seizures. N Engl J Med 1998, 338:429-434.
4. Ramos-Linzana J, Cassinello GE, Carrasco LL, et al.: Seizure recurrence after a first unprovoked seizure in childhood: a prospective study. Epilepsia 2000, 41:1005-1013.
5. O'Dell C, Shinnar S: Initiation and discontinuation of antiepileptic drugs. Neurol Clin 2001, 19:289-311.
6. Marson A, Jacoby A, Johnson A, et al.: Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomized controlled trial. Lancet 2005, 365:2007-2013.
7. Kim LG, Johnson TL, Marson AG, et al.: Prediction of risk of seizure recurrence after a single seizure and early epilepsy: further results from the MESS trial. Lancet Neurol 2006, 5:317-322.
8. Berg AT: Risk of recurrence after a first unprovoked seizure. Epilepsia 2008, 49:13-18.
9. Shih JJ, Ochoa JG: Systematic review of antiepileptic drug initiation and withdrawal. Neurologist 2009, 15:122-131.
10. Schreiner A, Phlmann-Eden B: Value of the early electroencephalogram after a first unprovoked seizure. Clin Electroencephalogr 2003, 34:140-144.
11. Kwan P, Brodie MJ: Early identification of refractory epilepsy. N Engl J Med 2000, 342:314-319.
12. Berg AT, Shinnar S: Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology 1994, 44:601-608.
13. American Academy of Neurology: Practice parameter: a guideline for discontinuing antiepileptic drugs in seizure-free patients-summary statement. Neurology 1996, 47:600-602.
14. Medical Research Council Antiepileptic Drug Withdrawal Study Group: Randomised study of antiepileptic drug withdrawal in patients in remission. Lancet 1991, 337:1175-1180.
15. Specchio LM, Tramacere L, La Neve A, et al.: Discontinuing antiepileptic drugs in patients who are seizure-free on monotherapy. J Neurol Neurosurg Psychiatry 2002, 72:22-25.
16. Aktekin B, Dogan EA, Oguz Y, et al.: Withdrawal of antiepileptic drugs in adult patients free of seizures for 4 years: a prospective study. Epilepsy Behav 2006, 8:616-619.
17. • Lossius MI, Hessen E, Mowinckel P, et al.: Consequences of antiepileptic drug withdrawal: a randomized, double-blind study. Epilepsia 2008, 3:455-463.
18. Schmidt D: Antiepileptic drug withdrawal in seizure-free patients. Lancet 2008, 372:610-611.
19. Specchio LM, Beghi E: Should antiepileptic drugs be withdrawn in seizure-free patients? CNS Drugs 2004, 4:201-212.
20. Callaghan N, Garrett A, Goggin T: Withdrawal of anticonvulsant drugs in patients free of seizures fortwo years. A prospective study. N Engl J Med 1988, 318:942-946.
21. Cardoso TAM: Hippocampal abnormalities and seizure recurrence after antiepileptic drug withdrawal. Neurology 2006, 67:134-136.
22. Camfield P, Camfield C:When is it safe to discontinue AED treatment? Epilepsia 2008, 49(Suppl 9):25-28.
23. Peters ACB, Brouwer OF, Geerts AT, et al.: Randomized prospective study of early discontinuation of antiepileptic drugs in children with epilepsy. Neurology 1998, 50:724-730.
24. Tennison M, Greenwood R, Lewis D, et al.: Discontinuing antiepileptic drugs in children with epilepsy: a comparison of a six-week and a nine-month taper period. N Engl J Med 1994, 330:1407-1410.
25. Verrotti A,Morresi S, Basciani F, et al.: Discontinuation of anticonvulsant therapy in children with partial epilepsy. Neurology 2000, 55:1393-1395.
26. Geerts AT, Niermeijer JM, Peters AC, et al.: Four-year outcome after early withdrawal of antiepileptic drugs in childhood epilepsy. Neurology 2005, 64:2136-2138.
27. Camfield P, Camfield C: The frequency of intractable seizures after stopping AEDs in seizure-free children with epilepsy. Neurology 2005, 64:973-975.
28. Sillanpaa M, Schmidt D: Prognosis of seizure recurrence after stopping antiepileptic drugs in seizure-free patients: a long-term population-based study of childhood-onset epilepsy. Epilepsy Behav 2006, 8:713-719.
29. Olmez A, Arslan U, Turanli G, et al.: Risk of recurrence after drug withdrawal in childhood epilepsy. Seizure 2009, 18:251-256.
30. Ramos-Lizana J, Aguirre-Rodriguez J, Aguilera-Lopez P, Cassinello-Garcia E: Recurrence risk after withdrawal of antiepileptic drugs in children with epilepsy: a prospective study. Eur J Paediatr Neurol 2010, 14:116-124.
31. Camfield PR, Camfield CS: Childhood epilepsy: what is the evidence for what we think and what we do? J Child Neurol 2003, 18:272-287.
32. Andersson T, Braathen G, Persson A, et al.: A comparison between one and three years of treatment in uncomplicated childhood epilepsy: a prospective study. The EEG as predictor of outcome after withdrawal of treatment. Epilepsia 1997, 38:225-232.
33. St. Louis EK: Minimizing AED adverse effects: improving quality of life in the interictal state in epilepsy care. Curr Neuropharm 2009, 7:106-114.
34. Jacoby A: Psychosocial outcomes of antiepileptic drug discontinuation. Epilepsia 1992, 33:1123-1131.
35. Hessen E, Lossius MI, Reinvang I, Gjerstad L: Influence of major antiepileptic drugs on neuropsychological function: results from a randomized, double-blind, placebo-controlled withdrawal study of seizure-free epilepsy patients on monotherapy. J Int Neuropsychol Soc 2007, 13:393-400.
36. Lossius HE, MI RI, Gjerstad L: Slight improvement in mood and irritability after antiepileptic drug withdrawal: a controlled study in patients on monotherapy. Epilepsy Behav 2007, 10:449-455.
37. Schmidt D, Loscher W: Uncontrolled epilepsy following discontinuation of antiepileptic drugs in seizure-free patients: a review of current clinical experience. Acta Neurol Scand 2005, 111:291-300.
38. • Sirven J, SperlingMR,WingerchukDM: Early versus late antiepileptic drug withdrawal for people with epilepsy in remission. The Cochrane Library 2010, Issue 4. This study used the Cochrane database to assess the effect of length of seizure remission on outcome following AED withdrawal. The paper concluded for pediatric patients that a period of 2 years seizure-free was appropriate (Class I). However, no Class I studies were found for the adult population, making a determination difficult.
39. Serra JG, Montenegro MA, Guerreiro MM: Antiepileptic drug withdrawal in childhood: Does the duration of tapering off matter for seizure recurrence? J Child Neurol 2005, 20:624-626.
40. Ranganathan LN, Ramaratnam S: Rapid versus slow withdrawal of antiepileptic drugs. Cochrane Database Syst Rev 2006, 2:CD005003.
41. Berg AT, Langfitt JT, Spencer SS, Vickrey BG: Stopping antiepileptic drugs after epilepsy surgery: a survey of U.S. epilepsy center neurologists. Epilepsy Behav 2007, 10:219-222.
42. McIntosh AM, Kalnins RM, Mitchell LA, et al.: Temporal lobectomy: long-term seizure outcome, late recurrence and risks for seizure recurrence. Brain 2004, 127:2018-2030.
43. Berg AT, Vickrey BG, Langfitt JT, et al.: Reduction of AEDs in postsurgical patients who attain remission. Epilepsia 2006, 47:64-71.
44. Kerling F, Pauli E, Lorber B, et al.: Drug withdrawal after successful epilepsy surgery: How safe is it? Epilepsy Behav 2009, 15:476-480.
45. Yoon HH, Kwon HL, Mattson RH, et al.: Long-term seizure outcome in patients initially seizure-free after resective epilepsy surgery. Neurology 2003, 61:445-450.
46. Park KI, Lee SK, Chu K, et al.: Withdrawal of antiepileptic drugs after neocortical epilepsy surgery. Ann Neurol 2010, 67:230-238.
47. Engel J, Van Ness PC, Rasmussen TB, et al.: Outcome with respect to epileptic seizures. In Surgical Treatment of the Epilepsies. By Engel J. New York: Raven Press; 2003:609-621.
48. • Cole AJ, Wiebe S: Debate: Should antiepileptic drugs be stopped after successful epilepsy surgery? Epilepsia 2008, 49(Suppl 9):29-34. This review article debates the risks and benefits of attempting AED discontinuation after successful epilepsy surgery. The authors present the current state of evidence for the specific situation of seizure remission following surgery, highlighting a lack of rigorous scientific methodology.