A2 Vertaisarvioitu katsausartikkeli tieteellisessä lehdessä
Stopping epilepsy treatment in seizure remission: Good or bad or both?
Tekijät: Schmidt D, Sillanpaa M
Kustantaja: W B SAUNDERS CO LTD
Julkaisuvuosi: 2017
Journal: Seizure - European Journal of Epilepsy
Tietokannassa oleva lehden nimi: SEIZURE-EUROPEAN JOURNAL OF EPILEPSY
Lehden akronyymi: SEIZURE-EUR J EPILEP
Vuosikerta: 44
Aloitussivu: 157
Lopetussivu: 161
Sivujen määrä: 5
ISSN: 1059-1311
eISSN: 1532-2688
DOI: https://doi.org/10.1016/j.seizure.2016.09.003
Tiivistelmä
Purpose: To review the outcome of epilepsy after stopping antiepileptic drugs in remission.Results: Stopping antiepileptic drugs (AEDs) in remission is routinely done in many patients. Although the consequences of an unexpected relapse seizure in the 2 years after stopping AEDs may cause anguish and social issues, the impact on the long term seizure outlook of the epilepsy is minimal, if any. Discontinuation of drug treatment does not seem to affect the long-term prognosis but exposes patients who were seizure-free for years to a transient two-fold risk of seizures for the first 2 years after stopping AEDs. In addition, 20% of patients who were seizure-free for years, do not become seizure-free immediately after restarting AED treatment after relapse. The list of potential pitfalls is long. Patients with juvenile myoclonic epilepsy, those with prior withdrawal attempts and late remission have a higher risk of relapse.Conclusion: Stopping AEDs in remission does not affect the long-term patterns of epilepsy and some patients report a better general health in a life without AEDs. High-risk patients should not be generally encouraged to stop their AEDs in remission. We need new drugs that combine anti-seizure and antiepileptogenic effects to prevent seizure relapse and flare up of epilepsy after stopping AEDs in remission. (C) 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Purpose: To review the outcome of epilepsy after stopping antiepileptic drugs in remission.Results: Stopping antiepileptic drugs (AEDs) in remission is routinely done in many patients. Although the consequences of an unexpected relapse seizure in the 2 years after stopping AEDs may cause anguish and social issues, the impact on the long term seizure outlook of the epilepsy is minimal, if any. Discontinuation of drug treatment does not seem to affect the long-term prognosis but exposes patients who were seizure-free for years to a transient two-fold risk of seizures for the first 2 years after stopping AEDs. In addition, 20% of patients who were seizure-free for years, do not become seizure-free immediately after restarting AED treatment after relapse. The list of potential pitfalls is long. Patients with juvenile myoclonic epilepsy, those with prior withdrawal attempts and late remission have a higher risk of relapse.Conclusion: Stopping AEDs in remission does not affect the long-term patterns of epilepsy and some patients report a better general health in a life without AEDs. High-risk patients should not be generally encouraged to stop their AEDs in remission. We need new drugs that combine anti-seizure and antiepileptogenic effects to prevent seizure relapse and flare up of epilepsy after stopping AEDs in remission. (C) 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
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