Evidence map›Paper›PMID 29218705›Full record

Trial reportEpilepsia2018

Randomized controlled study comparing the efficacy of rapid and slow withdrawal of antiepileptic drugs during long-term video-EEG monitoring.

Shambhu Kumar, Bhargavi Ramanujam, P S Chandra, Deepa Dash, Santosh Mehta, Sharma Anubha, Renjith Appukutan, Manit Kumar Rana, Manjari Tripathi

Abstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Epilepsia, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. The value of ictal scalp EEG in focal epilepsies surgery: a retrospective analysis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Shambhu KumarDepartment of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Bhargavi RamanujamDepartment of Neurology, All India Institute of Medical Sciences, New Delhi, India.
P S ChandraDepartment of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Deepa DashDepartment of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Santosh MehtaDepartment of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Sharma AnubhaDepartment of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Renjith AppukutanDepartment of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Manit Kumar RanaDepartment of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Manjari TripathiDepartment of Neurology, All India Institute of Medical Sciences, New Delhi, India.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveAntiepileptic drugs (AEDs) are routinely withdrawn during long-term video-electroencephalography (EEG) monitoring (LTM), to record sufficient number of seizures. The efficacy of rapid and slow AED taper has never been compared in a randomized control trial (RCT), which was the objective of this study.

methodsIn this open-label RCT, patients aged 2-80 years with drug-resistant epilepsy (DRE) were randomly assigned (1:1) to rapid and slow AED taper groups. Outcome assessor was blinded to the allocation arms. Daily AED dose reduction was 30% to 50% and 15% to <30% in the rapid and slow taper groups, respectively. The primary outcome was difference in mean duration of LTM between the rapid and slow AED taper groups. Secondary outcomes included diagnostic yield, secondary generalized tonic-clonic seizure (GTCS), 4- and 24- hour seizure clusters, status epilepticus, and need for midazolam rescue treatment. The study was registered with Clinical Trial Registry-India (CTRI/2016/08/007207).

resultsOne hundred forty patients were randomly assigned to rapid (n = 70) or slow taper groups (n = 70), between June 13, 2016 and February 20, 2017. The difference in mean LTM duration between the rapid and slow taper groups was -1.8 days (95% confidence interval [CI] -2.9 to -0.8, P = .0006). Of the secondary outcome measures, time to first seizure (2.9 ± 1.7 and 4.6 ± 3.0 days in the rapid and slow taper groups respectively, P = .0002) and occurrence of 4-hour seizure clusters (11.9% and 2.9% in the rapid and slow taper groups, respectively, P = .04) were statistically significant. None of the other safety variables were different between the 2 groups. LTM diagnostic yield was 95.7% and 97.1%, in rapid and slow taper groups respectively (P = .46). SIGNIFICANCE: Rapid AED tapering has the advantage of significantly reducing LTM duration over slow tapering, without any serious adverse events.

Indexed as

AdolescentAdultAgedAged, 80 and overAnticonvulsantsChildChild, PreschoolDrug Resistant EpilepsyElectroencephalographyFemaleHumansMaleMiddle AgedSeizuresSingle-Blind MethodStatus EpilepticusAnticonvulsantsantiepileptic drug withdrawallong-term video-EEG monitoringresistant epilepsy

Identifiers

PMID29218705

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.