Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy.
Epilepsy Behav. 2021 Apr;117:107871. doi: 10.1016/j.yebeh.2021.107871. Epub 2021 Mar 6.
To compare withdrawal of antiseizure medications (ASM) to continued treatment in newly diagnosed individuals achieving seizure freedom, and assess the risk of relapse and factors associated with relapse.
This is a multicenter retrospective cohort study with long-term follow-up. Patients with newly diagnosed epilepsy were identified from the medical records of 13 Italian epilepsy centers and followed up until the most recent visit or death. Seizure-free patients discontinuing treatment were compared to patients who maintained treatment for baseline characteristics. Treatment was stopped upon clinical judgment. The probability of relapse was calculated with the Kaplan-Meier method. Demographic, clinical, and instrumental variables associated with relapse were assessed with Cox proportional hazards models.
One thousand and six patients aged 1 month to 72 years at diagnosis were enrolled and followed up for 17,892 person-years (median follow-up, 9.9 years). Three hundred and twenty patients (31.8%) underwent one or more treatment discontinuations. Factors associated with ASM withdrawal were younger age at remission and normal psychiatric examination. The probability of relapse after the first withdrawal was 16% at six months, 24% at 12 months, and 36%, 45%, and 53% at three, five, and ten years, respectively. The probability of remission after the first relapse was 59% at one month, 67%, 72, and 76% at three, six, and 12 months, respectively. Variables associated with relapse were age 14+ years, structural etiology, abnormal neuroimaging, ASM initiation after a single seizure, and symptomatic/cryptogenic epilepsy.
About one half of seizure-free patients stopping ASM relapse in 10 years. However, the possibility of remission after relapse is high, particularly in children and patients with idiopathic/cryptogenic epilepsy. Treatment deprescription might be encouraged at least in these patients.
比较新诊断为癫痫且已无癫痫发作的患者中停用抗癫痫药物（ASM）与继续治疗的效果，评估复发风险及与复发相关的因素。
这是一项多中心回顾性队列研究，进行了长期随访。从 13 家意大利癫痫中心的病历中确定了新诊断为癫痫的患者，并随访至最近一次就诊或死亡。比较了停用治疗的无癫痫发作患者与继续治疗的患者的基线特征。根据临床判断停止治疗。用 Kaplan-Meier 法计算复发概率。采用 Cox 比例风险模型评估与复发相关的人口统计学、临床和仪器变量。
共纳入 1060 例年龄在 1 个月至 72 岁的患者，中位随访时间为 9.9 年，随访总人年数为 17892。320 例（31.8%）患者经历了一次或多次治疗中断。与 ASM 停药相关的因素是缓解时年龄较小和正常的精神检查。第一次停药后 6 个月、12 个月、3 年、5 年和 10 年的复发概率分别为 16%、24%、36%、45%和 53%。第一次复发后缓解的概率分别为 1 个月时的 59%、3 个月时的 67%、6 个月时的 72%、12 个月时的 76%。与复发相关的变量包括年龄 14 岁以上、结构性病因、异常神经影像学、单次发作后开始 ASM 治疗以及症状性/隐源性癫痫。
大约一半无癫痫发作的停药患者在 10 年内复发。然而，复发后缓解的可能性很高，尤其是在儿童和特发性/隐源性癫痫患者中。至少在这些患者中，可以鼓励减少治疗。
