Prediction of seizure recurrence risk following discontinuation of antiepileptic drugs
| العنوان: | Prediction of seizure recurrence risk following discontinuation of antiepileptic drugs |
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| المؤلفون: | Eleonora Rosati, Margherita Contento, Martina Biggi, Bruno Bertaccini, Ylenia Failli, Matteo Magliani, Luca Massacesi, Marco Paganini |
| المصدر: | Epilepsia |
| بيانات النشر: | Wiley, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | medicine.medical_specialty, Multivariate analysis, Population, AED withdrawal, anti-seizure medications, epilepsy, Epilepsy, Recurrence, Risk Factors, Seizures, Internal medicine, Humans, Medicine, education, Retrospective Studies, Univariate analysis, education.field_of_study, business.industry, Hazard ratio, AED withdrawal, medicine.disease, Confidence interval, Discontinuation, anti‐seizure medications, Neurology, Cohort, Full‐length Original Research, epilepsy, Anticonvulsants, Neurology (clinical), business |
| الوصف: | Objective Discontinuation of antiepileptic drugs (AEDs) in seizure‐free patients is an important goal because of possible long‐term side effects and the social stigma burden of epilepsy. The purpose of this work was to assess seizure recurrence risk after suspension of AEDs, to evaluate predictors for recurrence, and to investigate the recovery of seizure control after relapse. In addition, the accuracy of a previously published prediction model of seizure recurrence risk was estimated. Methods Seizure‐free patients with epilepsy who had discontinued AEDs were retrospectively enrolled. The frequency of seizure relapses after AED withdrawal as well as prognosis after recurrence were assessed and the predictive role of baseline clinical‐demographic variables was evaluated. The aforementioned prediction model was also validated and its accuracy assessed at different seizure‐relapse probability levels. Results The enrolled patients (n = 133) had been followed for a median of 3 years (range 0.8–33 years) after AED discontinuation; 60 (45%) of them relapsed. Previous febrile seizures in childhood (hazard ratio [HR] 3.927; 95% confidence interval [CI] 1.403–10.988), a seizure‐free period on therapy of less than 2 years (HR 2.313; 95% CI 1.193–4.486), and persistent motor deficits (HR 4.568; 95% CI 1.412–14.772) were the clinical features associated with relapse risk in univariate analysis. Among these variables, only a seizure‐free period on therapy of less than 2 years was associated with seizure recurrence in multivariate analysis (HR 2.365; 95% CI 1.178–4.7444). Pharmacological control of epilepsy was restored in 82.4% of the patients who relapsed. In this population, the aforementioned prediction model showed an unsatisfactory accuracy. Significance A period of freedom from seizure on therapy of less than 2 years was the main predictor of seizure recurrence. The accuracy of the previously described prediction tool was low in this cohort, thus suggesting its cautious use in real‐world clinical practice. |
| تدمد: | 1528-1167 0013-9580 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::99dcea63be690d64c6cb4a4a4c9ec39b https://doi.org/10.1111/epi.16993 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....99dcea63be690d64c6cb4a4a4c9ec39b |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15281167 00139580 |
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