Neuropsychiatric Disease and Treatment (Jan 2023)
Relapse After Drug Withdrawal in Patients with Epilepsy After Two Years of Seizure-Free: A Cohort Study
Abstract
Xiaoli Zhang,1,* Jiao Zeng,1,* Xin Gu,1 Fan Zhang,1 Yongkai Han,1 Ping Zhang,1 Qun Wang,2,3 Renjun Gu1 1Department of Neurology, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, People’s Republic of China; 2Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 3China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Renjun Gu, Department of Neurology, The Second Affiliated Hospital of Xinxiang Medical University, Qianjin Road, No. 207, Xinxiang, Henan, People’s Republic of China, Tel +86 0373-3373704, Email [email protected] Qun Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Nansihuanxi Road, No. 119, Beijing, People’s Republic of China, Tel +86 010-59975052, Email [email protected] and Study Aims: Antiepileptic drugs are the first choice of treatment for patients with epilepsy. However, the withdrawal of antiepileptic drugs after seizure-free remains a significant focus for the majority of patients with epilepsy and their families. In this study, we evaluated the risk factors associated with relapse after drug withdrawal in patients with seizure free for 2 years. We aimed to guide patients in seizure-free to assess the risk of drug withdrawal.Patients and Methods: Through screening, 452 patients with epilepsy were included in the study.Patients were followed up for at least 2 years or more. Analyzed their clinical data by applying the χ 2-test, Kaplan-Meier survival analysis and multivariate Cox regression analysis.Results: 423 patients completed follow-up, of which 304 cases recurred (71.9%).Related recurrence factors include age of onset, type of seizure, number of AEDs, seizure-free time before withdrawal, and electroencephalogram (EEG) results before drug withdrawal (P< 0.05). The results of correlation analysis showed that age of onset, seizure frequency, seizure type, number of AEDs, the period from AEDs treatment to a seizure-free status, EEG results before drug withdrawal, and pre-medication course, were all significantly related to the recurrence of seizures after drug reduction and withdrawal (P< 0.05). We identified a range of independent risk factors, including onset age, seizure frequency, Multiple AEDs and the period from AEDs treatment to a seizure-free status.Conclusion: The overall recurrence rate of epilepsy in our patient cohort was high, and the peak recurrence period was within one-year of drug withdrawal. Patients with partial seizures, a short seizure-free time before withdrawal, severe EEG abnormalities before drug reduction, and a long course of the disease, are prone to relapse. Patients with an older age at onset and a high frequency of attack, those taking multi-drug combination therapy, and those that take a long time to gain control, should be managed carefully to AEDs withdrawal.Keywords: epilepsy, relapse, antiepileptic drugs, drug withdrawal
