Stichting Epilepsie Instellingen Nederland, Department of Clinical Neurophysiology, Zwolle, The Netherlands.
Stichting Epilepsie Instellingen Nederland, Department of Clinical Neurophysiology, Zwolle, The Netherlands.
Seizure. 2018 Mar;56:9-13. doi: 10.1016/j.seizure.2018.01.016. Epub 2018 Jan 31.
Long-term video-EEG monitoring (LTM) is frequently used for diagnostic purposes and in the workup of epilepsy surgery to determine the seizure onset zone. Different strategies are applied to provoke seizures during LTM, of which withdrawal of anti-epileptic drugs (AED) is most effective. Remarkably, there is no standardized manner of AED withdrawal. For instance, the majority of clinics taper medication during clinical admission, whereas we prefer to taper medication at home prior to admission. Our aim was to study the advantages (efficiency and diagnostic yield) and disadvantages (safety and complication rates) of predominantly tapering of medication at home.
We report a retrospective observational cohort of 273 patients who had a LTM at our tertiary epilepsy center from 2005 until 2011. Provocation methods to induce seizures were determined on individual basis. Success rate (duration of admittance, time to first seizure, efficiency and diagnostic yield) and complications and serious adverse events were assessed.
AED were tapered in 180 (66%) patients, in 93 (24%) of these patients with additional (partial) sleep deprivation. In all of these patients tapering started at home one to four weeks prior to admission. In the other patients, only (partial) sleep deprivation or none provocation method at all was applied. Seizure recordings were successful in 79,9% of patients. Complications occurred in 19 patients (10.9%) of which 3 had (1.7%) serious adverse events (status epilepticus (SE)) with AED withdrawal. These complications only occurred during admittance, not at home.
AED withdrawal at home prior to LTM is an efficient and convenient method to increase the diagnostic yield of LTM and appears relatively safe.
长程视频脑电图监测（LTM）常用于诊断目的和癫痫手术的评估，以确定癫痫发作起始区。在 LTM 期间，有多种策略可用于诱发癫痫发作，其中停用抗癫痫药物（AED）最有效。值得注意的是，目前还没有标准化的 AED 停药方式。例如，大多数诊所会在住院期间逐渐减少药物剂量，而我们则倾向于在入院前在家中逐渐减少药物剂量。我们的目的是研究主要在家中逐渐减少药物剂量的优势（效率和诊断产量）和劣势（安全性和并发症发生率）。
我们报告了一项回顾性观察队列研究，该研究纳入了 2005 年至 2011 年期间在我们的三级癫痫中心进行 LTM 的 273 例患者。根据个体情况确定诱发癫痫发作的方法。评估成功率（住院时间、首次发作时间、效率和诊断产量）以及并发症和严重不良事件。
180 例（66%）患者逐渐减少了 AED 的剂量，其中 93 例（24%）患者还进行了（部分）睡眠剥夺。在所有这些患者中，减少剂量的过程都是从入院前一周到四周在家中开始的。在其他患者中，仅应用了（部分）睡眠剥夺或根本没有任何诱发方法。有 79.9%的患者癫痫记录成功。19 例患者发生了并发症（10.9%），其中 3 例（1.7%）因 AED 停药出现严重不良事件（癫痫持续状态（SE））。这些并发症仅在住院期间发生，而不是在家中。
在 LTM 之前在家中逐渐减少 AED 剂量是一种有效且方便的方法，可以提高 LTM 的诊断产量，且似乎相对安全。
