Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Department of Neurosurgery, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
J Clin Neurosci. 2014 Jun;21(6):997-1001. doi: 10.1016/j.jocn.2013.09.019. Epub 2013 Nov 26.
This study explored the relapse rates and risk factors for seizure recurrence after discontinuing antiepileptic drug (AED) therapy among seizure-free patients in west China, and explored whether to reinstitute AED immediately after a single seizure after AED withdrawal. Patients with epilepsy who were seizure-free for at least 2 years and decided to gradually stop AED therapy were followed up every 3 months for seizure relapse. Patients who experienced their first seizure after drug withdrawal were divided into two groups according to their willingness to reinstitute AED therapy, and were followed up until their second seizure. In the mean 29.35 months of follow-up, 37 patients (37/162, 22.8%) suffered at least one seizure after withdrawal. The cumulative probability of seizure recurrence was 16% at 12 months and 20.2% at 24 months. AED response time >1 year and multiple types of seizure were identified as risk factors for seizure recurrence. Eight patients (8/32, 25%) suffered a second seizure within 1 year after the first whether or not they reinstituted AED immediately. There were no significant demographic or clinical differences between patients who reinstituted AED therapy and those who did not. The epilepsy recurrence rate after AED withdrawal is relatively low, with a relatively slow tapering process. Patients with long AED response times and/or multiple types of seizures have a higher risk of seizure recurrence. The first seizure after drug withdrawal is not an indication for immediate AED reinstitution, but may be recommended after a second seizure.
本研究旨在探讨中国西部停药后无癫痫发作患者的癫痫复发率和复发风险因素，并探讨单次停药后癫痫发作后是否应立即重新开始抗癫痫药物（AED）治疗。
癫痫无发作至少 2 年且决定逐渐停止 AED 治疗的患者，每 3 个月随访一次癫痫复发情况。停药后出现首次癫痫发作的患者根据是否愿意重新开始 AED 治疗分为两组，并随访至第二次癫痫发作。在平均 29.35 个月的随访中，37 例（37/162，22.8%）患者在停药后至少发生了一次癫痫发作。癫痫复发的累积概率为 12 个月时为 16%，24 个月时为 20.2%。AED 反应时间>1 年和多种类型的癫痫发作被确定为癫痫复发的风险因素。首次癫痫发作后，8 例（8/32，25%）患者在 1 年内再次发作，无论是否立即重新开始 AED 治疗。重新开始 AED 治疗的患者与未重新开始 AED 治疗的患者在人口统计学和临床方面没有显著差异。
AED 停药后癫痫复发率相对较低，且逐渐减量过程较慢。AED 反应时间较长和/或多种类型癫痫发作的患者癫痫复发风险较高。停药后首次癫痫发作并非立即重新开始 AED 治疗的指征，但可能在第二次癫痫发作后推荐。
