Observational studyCNS drugs2019
Relative Seizure Relapse Risks Associated with Antiepileptic Drug Withdrawal After Different Seizure-Free Periods in Adults with Focal Epilepsy: A Prospective, Controlled Follow-Up Study.
Observational study in CNS drugs, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 17 citations in OpenAlex.
- Risk factors of recurrence for epilepsy patients after antiseizure medication withdrawal: what we do and do not know?Journal of neurology · 2025Review
- Non-discontinuation of antiseizure medication in seizure-free patients with epilepsy: Reasons and predictors among neurologists and patients.Epilepsia · 2025Article
- [Discontinuation of antiseizure medication in patients with epilepsy].Der Nervenarzt · 2024Review
- Impact of timing of antiseizure medication withdrawal on seizure recurrence in glioma patients: a retrospective observational study.Journal of neuro-oncology · 2023Observational
- The sense of stopping migraine prophylaxis.The journal of headache and pain · 2023Review
- Brain functional and structural characteristics of patients with seizure recurrence following drug withdrawal.Neuroradiology · 2021Article
- Prediction of seizure recurrence risk following discontinuation of antiepileptic drugs.Epilepsia · 2021Article
- Response to antiseizure medications in epileptic patients with malformation of cortical development.Therapeutic advances in neurological disorders · 2021Article
- Comparison of Long-Term Outcomes of Monotherapy and Polytherapy in Seizure-Free Patients With Epilepsy Following Antiseizure Medication Withdrawal.Frontiers in neurology · 2021Article
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Authors and funding
12 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundApproximately two-thirds of patients with newly diagnosed epilepsy become seizure-free after antiepileptic drug (AED) treatment. A crucial issue for these patients and their families, especially after a long period of seizure freedom, is when to stop their medications.
objectiveThe aim of this study was to identify the optimal timing of AED withdrawal in adults with focal epilepsy who had been seizure-free for ≥ 2 years.
methodsAdults with focal epilepsy who had been seizure-free for ≥ 2 years were recruited. Based on their decision to discontinue (withdrawal) or continue (non-withdrawal) AED treatment, patients were assigned to withdrawal or non-withdrawal subgroups according to the length of remission (2 to < 3 years, 3 to < 4 years, 4 to < 5 years and ≥ 5 years). The relapse risks of the withdrawal and corresponding non-withdrawal subgroups were compared, and the relative relapse risks were assessed in a Cox proportional hazard regression model.
resultsA total of 213 eligible patients began to withdraw from AED treatment; 70 had been seizure-free for 2 to < 3 years, 62 had been seizure-free for 3 to < 4 years, 37 had been seizure-free for 4 to < 5 years and 44 had been seizure-free for ≥ 5 years. The figures for the corresponding non-withdrawal subgroups were 463, 334, 251 and 182, respectively. There was a significantly higher risk of seizure relapse in patients withdrawing from AEDs after 2 to < 5 years of seizure freedom than in the corresponding non-withdrawal controls, and the relative relapse risk was 3.052 (95% confidence interval [CI] 2.126-4.381; p < 0.001) for the seizure-free period of 2 to < 3 years, 3.617 (95% CI 2.384-5.488; p < 0.001) for 3 to < 4 years and 2.644 (95% CI 1.456-4.799; p = 0.001) for 4 to < 5 years. However, for patients who were seizure-free for ≥ 5 years, AED withdrawal did not significantly increase the risk of seizure relapse compared with that of patients continuing treatment (hazard ratio [HR] 1.362, 95% CI 0.634-2.926, p = 0.428). Compared with a seizure-free period of 2 to < 3 years, the relative relapse risk after AED withdrawal was significantly reduced only after being seizure-free for ≥ 5 years (HR 0.441, 95% CI 0.233-0.834; p = 0.012).
conclusionOverall, for adults with focal epilepsy, withdrawal from AEDs significantly increased the risk of seizure relapse after being seizure-free for 2 to < 5 years, but might not increase the risk if the seizure-free period was ≥ 5 years.
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