Research on risk of recurrence after discontinuation of antiepileptic drugs in adults with focal epilepsy_Journal of Epilepsy

Authors：

ZHANG Jiaying ¹ , ZUO Jingwen ¹ , QIN Xueyin ² , DAI Yingyue ¹ , SHAO Xiaoqiu ¹ , WANG Qun ¹ ,  LV Ruijuan ¹

1. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China;
2. Epilepsy Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China;

Corresponding author：

LV Ruijuan, Email: lvruijuan@126.com

Keywords：

局灶性癫痫; 复发; 撤药; 影响因素

DOI：

10.7507/2096-0247.202507008

Video：

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Objective To evaluate the risk factors for seizure recurrence after withdrawal in adult patients with focal epilepsy who have been seizure-free for more than 3 years following drug treatment. Methods This study retrospectively included cases of adult patients with focal epilepsy treated with antiepileptic drugs at the outpatient department of Beijing Tiantan Hospital between January 2018 and October 2024. The chi-square test (or Fisher’s exact test) and logistic regression analysis were used to explore risk factors for seizure recurrence after withdrawal. Results This study analyzed 397 patients with focal epilepsy who maintained seizure-free for more than 3 years with complete clinical data. Among them, 286 patients maintained seizure-free without medication reduction, 2 patients did not reduce medication but experienced recurrence, 73 patients experienced recurrence after medication reduction, and 36 patients remained seizure-free after medication reduction. Among 109 patients with focal epilepsy who withdrew medication after more than 3 years of seizure freedom, 73 (66.97%) experienced recurrence. Univariate analysis revealed no significant correlation between gender, age at onset, comorbidities, or number of antiepileptic drugs and post-withdrawal recurrence (all P > 0.05). Shorter seizure-free duration and abnormal brain MRI findings were identified as risk factors for recurrence after withdrawal (P<0.05). Multivariate logistic regression analysis confirmed that seizure-free duration<4 years and abnormal intracranial lesion were independent risk factors for post-withdrawal recurrence (P<0.05). Conclusions Shorter seizure-free duration and abnormal intracranial lesion are risk factors for seizure recurrence after withdrawal in adult patients with focal epilepsy who have been seizure-free for≥3 years.

Citation： ZHANG Jiaying, ZUO Jingwen, QIN Xueyin, DAI Yingyue, SHAO Xiaoqiu, WANG Qun, LV Ruijuan. Research on risk of recurrence after discontinuation of antiepileptic drugs in adults with focal epilepsy. Journal of Epilepsy, 2025, 11(6): 477-481. doi: 10.7507/2096-0247.202507008 Copy

1.	GBD 2016 Epilepsy Collaborators. Global, regional, and national burden of epilepsy, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol, 2019, 18(4): 357-375.
2.	Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 2010, 51(6): 1069-1077.
3.	Sarkis RA, Goksen Y, Mu Y, et al. Cognitive and fatigue side effects of anti-epileptic drugs: an analysis of phase III add-on trials. J Neurol, 2018, 265(9): 2137-4212.
4.	Chen B, Choi H, Hirsch LJ, et al. Cross-sensitivity of psychiatric and behavioral side effects with antiepileptic drug use. Seizure, 2018, 62: 38-42.
5.	VerrottI A, Lattanzi S, Brigo F, et al. Pharmacodynamic interactions of antiepileptic drugs: From bench to clinical practice. Epilepsy Behav, 2020, 104(Pt A): 106939.
6.	Lossius MI, Hessen E, Mowinckel P, et al. Consequences of antiepileptic drug withdrawal: a randomized, double-blind study (Akershus Study). Epilepsia, 2008, 49(3): 455-463.
7.	Lamberink HJ, Otte WM, Geerts AT, et al. Individualised prediction model of seizure recurrence and long-term outcomes after withdrawal of antiepileptic drugs in seizure-free patients: a systematic review and individual participant data meta-analysis. Lancet Neurol, 2017, 16(7): 523-531.
8.	SChmidt D, Löscher W. Uncontrolled epilepsy following discontinuation of antiepileptic drugs in seizure-free patients: a review of current clinical experience. Acta Neurol Scand, 2005, 111(5): 291-300.
9.	中国抗癫痫协会. 临床诊疗指南——癫痫病分册(2023修订版). 北京: 人民卫生出版社, 2023.
10.	Berg AT, Shinnar S. Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology, 1994, 44(4): 601-608.
11.	Afshari D, Moradian N. Evaluating the rate of recurrence of epilepsy after therapy discontinuation in 2-year seizure-free epileptic patients. Int J Neurosci, 2012, 122(10): 598-601.
12.	He RQ, Zeng QY, Zhu P, et al. Risk of seizure relapse after antiepileptic drug withdrawal in adult patients with focal epilepsy. Epilepsy Behav, 2016, 64(Pt A): 233-238.
13.	羡一心. 癫痫小儿停药后复发的logistics回归分析. 中国医学工程, 2019, 27(7): 77-79.
14.	ODERO N, OYIEKE K, GWER S, et al. Risk factors for seizure recurrence after initial withdrawal of anti-seizure medications in children with epilepsy at Aga Khan University Hospital, Nairobi, Kenya. Epilepsy Behav Rep, 2023, 22: 100596.
15.	李经猷, 李洁敏. 儿童癫痫撤药后复发的影响因素分析. 智慧健康, 2023, 9(29): 73-76,80.
16.	何汝茜, 曾庆意, 朱攀, 等. 成人局灶性癫痫撤药后复发的风险及其危险因素探索. 中华医学会第十八次全国神经病学学术会议论文集, 2015: 1538.
17.	PARK S, LEE D H, KIM S W, et al. Prognostic analysis of patients with epilepsy according to time of relapse after withdrawal of antiepileptic drugs following four seizure-free years. Epilepsia, 2017, 58(1): 60-7.
18.	Todt H. The late prognosis of epilepsy in childhood: results of a prospective follow-up study. Epilepsia, 1984, 25(2): 137-144.
19.	Verrotti A, D'egidio C, Agostinelli S, et al. Antiepileptic drug withdrawal in childhood epilepsy: what are the risk factors associated with seizure relapse? Eur J Paediatr Neurol, 2012, 16(6): 599-604.
20.	马倩. 小儿癫痫病因及发病机制的研究进展. 医学综述, 2012, 18(4): 542-544.
21.	Wieshmann UC. Clinical application of neuroimaging in epilepsy. J Neurol Neurosurg Psychiatry, 2003, 74(4): 466-470.
22.	Von Oertzen J, Urbach H, Jungbluth S, et al. Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy. J Neurol Neurosurg Psychiatry, 2002, 73(6): 643-647.
23.	Su L, Di Q, Yu N, et al. Predictors for relapse after antiepileptic drug withdrawal in seizure-free patients with epilepsy. J Clin Neurosci, 2013, 20(6): 790-794.
24.	Medical Research Council Antiepileptic Drug Withdrawal Study Group. Randomised study of antiepileptic drug withdrawal in patients in remission. Lancet, 1991, 337(8751): 1175-1180.
25.	Wang X, He R, Zheng R, et al. 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. CNS Drugs, 2019, 33(11): 1121-1132.

1. GBD 2016 Epilepsy Collaborators. Global, regional, and national burden of epilepsy, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol, 2019, 18(4): 357-375.
2. Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 2010, 51(6): 1069-1077.
3. Sarkis RA, Goksen Y, Mu Y, et al. Cognitive and fatigue side effects of anti-epileptic drugs: an analysis of phase III add-on trials. J Neurol, 2018, 265(9): 2137-4212.
4. Chen B, Choi H, Hirsch LJ, et al. Cross-sensitivity of psychiatric and behavioral side effects with antiepileptic drug use. Seizure, 2018, 62: 38-42.
5. VerrottI A, Lattanzi S, Brigo F, et al. Pharmacodynamic interactions of antiepileptic drugs: From bench to clinical practice. Epilepsy Behav, 2020, 104(Pt A): 106939.
6. Lossius MI, Hessen E, Mowinckel P, et al. Consequences of antiepileptic drug withdrawal: a randomized, double-blind study (Akershus Study). Epilepsia, 2008, 49(3): 455-463.
7. Lamberink HJ, Otte WM, Geerts AT, et al. Individualised prediction model of seizure recurrence and long-term outcomes after withdrawal of antiepileptic drugs in seizure-free patients: a systematic review and individual participant data meta-analysis. Lancet Neurol, 2017, 16(7): 523-531.
8. SChmidt D, Löscher W. Uncontrolled epilepsy following discontinuation of antiepileptic drugs in seizure-free patients: a review of current clinical experience. Acta Neurol Scand, 2005, 111(5): 291-300.
9. 中国抗癫痫协会. 临床诊疗指南——癫痫病分册(2023修订版). 北京: 人民卫生出版社, 2023.
10. Berg AT, Shinnar S. Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology, 1994, 44(4): 601-608.
11. Afshari D, Moradian N. Evaluating the rate of recurrence of epilepsy after therapy discontinuation in 2-year seizure-free epileptic patients. Int J Neurosci, 2012, 122(10): 598-601.
12. He RQ, Zeng QY, Zhu P, et al. Risk of seizure relapse after antiepileptic drug withdrawal in adult patients with focal epilepsy. Epilepsy Behav, 2016, 64(Pt A): 233-238.
13. 羡一心. 癫痫小儿停药后复发的logistics回归分析. 中国医学工程, 2019, 27(7): 77-79.
14. ODERO N, OYIEKE K, GWER S, et al. Risk factors for seizure recurrence after initial withdrawal of anti-seizure medications in children with epilepsy at Aga Khan University Hospital, Nairobi, Kenya. Epilepsy Behav Rep, 2023, 22: 100596.
15. 李经猷, 李洁敏. 儿童癫痫撤药后复发的影响因素分析. 智慧健康, 2023, 9(29): 73-76,80.
16. 何汝茜, 曾庆意, 朱攀, 等. 成人局灶性癫痫撤药后复发的风险及其危险因素探索. 中华医学会第十八次全国神经病学学术会议论文集, 2015: 1538.
17. PARK S, LEE D H, KIM S W, et al. Prognostic analysis of patients with epilepsy according to time of relapse after withdrawal of antiepileptic drugs following four seizure-free years. Epilepsia, 2017, 58(1): 60-7.
18. Todt H. The late prognosis of epilepsy in childhood: results of a prospective follow-up study. Epilepsia, 1984, 25(2): 137-144.
19. Verrotti A, D'egidio C, Agostinelli S, et al. Antiepileptic drug withdrawal in childhood epilepsy: what are the risk factors associated with seizure relapse? Eur J Paediatr Neurol, 2012, 16(6): 599-604.
20. 马倩. 小儿癫痫病因及发病机制的研究进展. 医学综述, 2012, 18(4): 542-544.
21. Wieshmann UC. Clinical application of neuroimaging in epilepsy. J Neurol Neurosurg Psychiatry, 2003, 74(4): 466-470.
22. Von Oertzen J, Urbach H, Jungbluth S, et al. Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy. J Neurol Neurosurg Psychiatry, 2002, 73(6): 643-647.
23. Su L, Di Q, Yu N, et al. Predictors for relapse after antiepileptic drug withdrawal in seizure-free patients with epilepsy. J Clin Neurosci, 2013, 20(6): 790-794.
24. Medical Research Council Antiepileptic Drug Withdrawal Study Group. Randomised study of antiepileptic drug withdrawal in patients in remission. Lancet, 1991, 337(8751): 1175-1180.
25. Wang X, He R, Zheng R, et al. 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. CNS Drugs, 2019, 33(11): 1121-1132.

Journal of Epilepsy

Research on risk of recurrence after discontinuation of antiepileptic drugs in adults with focal epilepsy

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