Ilyas-Feldmann Maria, Graf Luise, Doerrfuss Jakob I, Dipper-Wawra Matthias, Doerr Nicoletta, Lehmann Rebekka, Meisel Christian, Steinbart David, Steinbrenner Mirja, Holtkamp Martin
Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
Epilepsy Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany.
Epilepsia. 2025 Jun 26. doi: 10.1111/epi.18519.
This study was undertaken to investigate clinical and psychosocial factors associated with antiseizure medication (ASM) non-discontinuation in seizure-free patients with epilepsy among both neurologists and patients.
In this cross-sectional study, neurologists documented their recommendations on ASM discontinuation (comprising both complete discontinuation and ≥25% dose reduction) in patients aged ≥18 years who had been seizure-free for at least 2 years. Based on these recommendations, patients made individual decisions. In both neurologists and patients, reasons for and predictors of ASM non-discontinuation were assessed considering demographic and epilepsy-related variables as well as standardized psychosocial questionnaires.
Among 196 patients (53.1% female, median age = 50 years, interquartile range [IQR] = 36-61; median seizure-free duration = 6 years, IQR = 4-11), neurologists recommended ASM discontinuation in 110 cases (56.1%), of which 29 patients (26.4%) agreed. Neurologists were more likely to favor ASM non-discontinuation if they had fewer years of professional experience (odds ratio [OR] = .96, 95% confidence interval [CI] = .92-.99) and if patients had shorter seizure-free durations (OR = .98, 95% CI = .98-.99). Among patients, longer seizure-free duration (OR = 1.01, 95% CI = 1.01-1.02) and a history of generalized or focal to bilateral tonic-clonic seizures (OR = 2.72, 95% CI = 1.15-6.43) were independently associated with ASM non-discontinuation. Excluding the 27 patients who favored a dose reduction, ASM non-discontinuation was still associated with a longer duration of seizure freedom (OR = 1.02, 95% CI = 1.01-1.03). Further predictors were higher anxiety scores (OR = 1.37, 95% CI = 1.05-1.78) and better ASM tolerability (OR = 1.04, 95% CI = 1.01-1.07).
Neurologists and, even more so, patients are hesitant to discontinue ASM, which was accomplished in only 15% of seizure-free patients. Duration of seizure freedom has a major impact on the decision but in opposite directions comparing both groups. Understanding these differing perspectives is essential to improve shared decision-making on this complex issue in epilepsy care.
本研究旨在调查癫痫发作已得到控制的患者中，与抗癫痫药物（ASM）不停用相关的临床和社会心理因素，涉及神经科医生和患者两个群体。
在这项横断面研究中，神经科医生记录了他们对于年龄≥18岁、癫痫发作已得到控制至少2年的患者停用ASM的建议（包括完全停用和剂量降低≥25%）。基于这些建议，患者做出个人决定。针对神经科医生和患者，研究评估了ASM不停用的原因及预测因素，考虑了人口统计学和癫痫相关变量以及标准化社会心理问卷。
在196例患者中（女性占53.1%，年龄中位数 = 50岁，四分位间距[IQR] = 36 - 61；癫痫发作控制的中位数时长 = 6年，IQR = 4 - 11），神经科医生建议停用ASM的有110例（56.1%），其中29例患者（26.4%）同意。神经科医生若专业经验年限较少（比值比[OR] = 0.96，95%置信区间[CI] = 0.92 - 0.99）以及患者癫痫发作控制时长较短（OR = 0.98，95% CI = 0.98 - 0.99），则更倾向于不建议停用ASM。在患者中，癫痫发作控制时长较长（OR = 1.01，95% CI = 1.01 - 1.02）以及有全面性发作或局灶性发作继发全面性强直 - 阵挛发作史（OR = 2.72，95% CI = 1.15 - 6.43）与ASM不停用独立相关。排除27例倾向于降低剂量的患者后，ASM不停用仍与更长的癫痫发作控制时长相关（OR = 1.02，95% CI = 1.01 - 1.03）。其他预测因素包括焦虑评分较高（OR = 1.37，95% CI = 1.05 - 1.78）以及对ASM的耐受性较好（OR = 1.04，95% CI = 1.01 - 1.07）。
神经科医生，甚至患者，对于停用ASM都很犹豫，在癫痫发作已得到控制的患者中只有15%实现了停药。癫痫发作控制时长对决策有重大影响，但两组的影响方向相反。了解这些不同观点对于改善癫痫护理中这一复杂问题的共同决策至关重要。
