Epilepsy is a treatable disease, and about 70% of patients with seizures can be controlled, at which point they face the problem of reducing or discontinuing antiepileptic drugs. Inappropriate reduction or discontinuation may have serious consequences for the patient, including seizure recurrence, prolonged treatment, and even persistent status epilepticus. The discontinuation process is much more complex than the administration of medication, and there is no single standard for discontinuation that applies to all patients with epilepsy; therefore, the reduction and discontinuation of medication in patients with epilepsy should be individualized. Du Xiubo, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
The pros and cons of medication reduction and discontinuation after seizure control has been one of the main concerns of epilepsy patients, their families and clinicians, mainly for the recurrence of epilepsy after medication reduction and discontinuation. According to the literature, the recurrence rate after medication reduction for those with seizure control up to 2 years is 12%-66%, and the results vary widely due to different study populations and design protocols. The results of the study showed that the relapse rate was about 25% within 1 year and 29% within 2 years from the start of the medication reduction. In one study of 31 patients, there were 280 patients who reduced and stopped medication under the guidance of a physician, and 82 relapsed, with a relapse rate of 29.29%. 26.43% (74/280) relapsed within 1 year after stopping medication and 28.21% (79/280) relapsed within 2 years after stopping medication, and most patients did not have a recurrence of epilepsy after reducing and stopping medication. In a randomized controlled clinical study comparing those who continued to take medication for >2 years after seizure control and those who discontinued medication, it was found that there was no statistically significant difference in the recurrence rate between groups within 1 year, but the neuropsychiatric symptoms of patients in the discontinuation group improved significantly. It is suggested that the majority of patients will benefit from discontinuation of medication after seizure control.
The International League Against Epilepsy classified different seizure types of epilepsy and epilepsy syndromes according to age of onset, seizure type, etiology, and EEG manifestations, among which certain patients with epilepsy and epilepsy syndromes had a higher success rate of medication reduction and discontinuation, such as those with central. For example, benign epilepsy in childhood with central-temporal spike distribution accounted for 5.40% of all childhood epilepsy, and the success rate of medication reduction and withdrawal was >90%. In some patients with epilepsy and epilepsy syndromes, the recurrence rate is higher after medication reduction, such as juvenile myoclonic epilepsy, which accounts for 3% to l l% of all epilepsies, and 86% of patients with recurrence after first treatment with valproic acid, but the recurrence rate is >90% after medication reduction. The results of a study also confirmed that the recurrence rate was lower in patients with benign childhood epilepsy and childhood aphasic epilepsy with central temporal spike emission, whereas the recurrence rate was higher in adolescents with myoclonic epilepsy and symptomatic partial epilepsy after medication reduction. Therefore, caution is needed when tapering the latter two seizure types, especially juvenile myoclonic epilepsy.
The results of the study showed that age of onset was one of the important influencing factors for seizure recurrence after medication reduction and discontinuation, with adolescent onset and adult onset being risk factors for seizure recurrence. The results are consistent with the high recurrence rate reported in the literature for those with onset at age 12.
For example, the peak age of onset of benign epilepsy in childhood with central-temporal spikes is 8-9 years, and 50% of adolescents with myoclonic epilepsy have onset at age 13-16 years. The absence of seizures for at least 2 years prior to medication reduction and discontinuation has been confirmed as a criterion for medication reduction and discontinuation. The difference in seizure recurrence rate after medication reduction and discontinuation was not statistically significant in patients with childhood-onset seizure control for 1 to 2 years compared with those with >2 years.
Although seizure control has been reported in the literature