Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany.
Center for Stroke Research Berlin, Berlin, Germany.
Eur J Neurol. 2024 Mar;31(3):e16160. doi: 10.1111/ene.16160. Epub 2023 Nov 28.
In patients with epilepsy and sustained seizure freedom, guidelines recommend considering discontinuation of antiseizure medication (ASM) based on shared decision-making. This study aims to identify factors associated with non-discontinuation of ASM in seizure-free patients.
Retrospective data from three sites of an academic outpatient clinic were analyzed. Adult patients with epilepsy who have been seizure-free for ≥24 months on ASM monotherapy were included. The primary end-point was non-discontinuation of ASM, defined as no discontinuation or no dose reduction of ≥25% at the last outpatient clinic visit in the ultimate seizure-free interval. Secondary end-points included frequency of discussion on discontinuation attempts between patients and physicians, adherence to ASM discontinuation decisions, and post-discontinuation seizure outcomes.
Out of 338 included patients, 81.7% did not discontinue ASM and did not reduce its dose, 11.5% discontinued ASM and 6.8% had a significant dose reduction. Factors independently associated with non-discontinuation of ASM were history of focal to bilateral or generalized tonic-clonic seizures (odds ratio [OR] 2.33, 95% confidence interval [CI] 1.08-5.06), history of breakthrough seizures (OR 3.32, 95% CI 1.10-10.04), history of failed attempts to discontinue or reduce the ASM dose (OR 4.67, 95% CI 1.03-21.11) and higher ASM load at the index visit (OR 6.10, 95% CI 2.09-17.78). Discontinuation attempts were made during the entire period of seizure freedom and were most commonly undertaken ≥10 years after the last seizure.
This study provides insights into factors associated with the shared decision-making process regarding ASM discontinuation in seizure-free patients and highlights the importance of considering individual patient characteristics and seizure history.
在癫痫发作且持续无发作的患者中，指南建议基于共同决策考虑停止抗癫痫药物（ASM）治疗。本研究旨在确定与无发作患者不停止 ASM 相关的因素。
对学术门诊三个地点的回顾性数据进行了分析。纳入在 ASM 单药治疗下无发作≥24 个月的成年癫痫患者。主要终点是不停止 ASM，定义为在最终无发作间期的最后一次门诊就诊时未停止或未减少≥25%的剂量。次要终点包括患者与医生之间关于停药尝试的讨论频率、ASM 停药决定的依从性以及停药后发作的结果。
在 338 例纳入的患者中，81.7%未停止 ASM 且未减少剂量，11.5%停止 ASM，6.8%剂量显著减少。与不停止 ASM 独立相关的因素包括局灶性到双侧或全面强直阵挛性发作史（比值比[OR]2.33，95%置信区间[CI]1.08-5.06）、突破发作史（OR 3.32，95%CI 1.10-10.04）、ASM 停药或减少剂量失败史（OR 4.67，95%CI 1.03-21.11）和指数就诊时 ASM 负荷更高（OR 6.10，95%CI 2.09-17.78）。停药尝试在整个无发作期间进行，最常在最后一次发作后≥10 年进行。
本研究提供了关于无发作患者停止 ASM 共同决策过程中相关因素的见解，并强调了考虑个体患者特征和发作史的重要性。
