Guld A T, Sabers A, Kjaer T W
Department of Neurology, Rigshospitalet, Copenhagen, Denmark.
Neurophysiology Center, Zealand University Hospital, University of Copenhagen, Denmark.
Acta Neurol Scand. 2017 Mar;135(3):302-307. doi: 10.1111/ane.12596. Epub 2016 Apr 7.
Anti-epileptic drugs (AED) are often tapered to reduce the time needed to record a sufficient number of seizure during long-term video-EEG monitoring (LTM). Fast AED reduction is considered less safe, but few studies have examined this. Our goal is to examine whether the rate of AED reduction affects efficiency and safety.
MATERIALS & METHODS: We performed a retrospective observational study of patients referred for presurgical evaluation. Each patient was categorized by two dichotomous parameters of AED tapering: (i) fast vs slow AED reduction the first 24 h of LTM and (ii) complete vs partial AED discontinuation during LTM.
Of 79 patients, 51% underwent a fast AED reduction and 58% ended up with AEDs completely discontinued. Complete AED discontinuation was associated with three times increased likelihood of receiving rescue therapy during LTM and double risk of having secondary generalized tonic-clonic seizures (sGTCS) compared to the group partially discontinued. Fast vs slow AED reduction had no effect on the safety of LTM. The fast AED reduction group and the complete AED discontinuation group had a significantly longer time to first seizure and total recording time compared to the slow AED reduction and partial discontinuation groups, respectively.
Fast AED reduction was found safe in patients undergoing presurgical video-EEG monitoring. Patients completely discontinued from AEDs had more sGTCS than patients partially discontinued. Further studies are suggested to confirm this finding and to evaluate whether fast reduction is safe and efficient in other subgroups of patients referred for LTM.
抗癫痫药物（AED）通常会逐渐减量，以减少长期视频脑电图监测（LTM）期间记录足够数量癫痫发作所需的时间。快速减少AED剂量被认为安全性较低，但很少有研究对此进行过考察。我们的目标是研究AED减量速度是否会影响效率和安全性。
我们对因术前评估而转诊的患者进行了一项回顾性观察研究。根据AED减量的两个二分参数对每位患者进行分类：（i）LTM的前24小时内AED快速减量与缓慢减量，以及（ii）LTM期间AED完全停用与部分停用。
在79例患者中，51%的患者AED快速减量，58%的患者最终AED完全停用。与部分停用组相比，AED完全停用与LTM期间接受抢救治疗的可能性增加三倍以及发生继发性全面强直阵挛发作（sGTCS）的风险加倍相关。AED快速减量与缓慢减量对LTM的安全性没有影响。与AED缓慢减量组和部分停用组相比，AED快速减量组和AED完全停用组分别首次发作的时间和总记录时间显著更长。
在接受术前视频脑电图监测的患者中，快速减少AED剂量被发现是安全的。与部分停用AED的患者相比，完全停用AED的患者发生sGTCS的情况更多。建议进一步研究以证实这一发现，并评估快速减量在转诊进行LTM的其他患者亚组中是否安全有效。
