ObjectiveTo explore the prognostic value of normal 24 hour video electroencephalography (VEEG) with different frequency on antiepileptic drugs (AEDs) withdrawal in cryptogenic epilepsy patients with three years seizure-free. MethodsA retrospective study was conducted in the Neurology outpatient and the Epilepsy Center of Xi Jing Hospital. The subject who had been seizure free more than 3 years were divided into continual normal twice group and once group according to the nomal frequence of 24 hour VEEG before discontinuation from January 2013 to December 2014, and then followed up to replase or to December 2015. The recurrence and cumulative recurrence rate of the two group after withdrawal AEDs were compared with chi-square or Fisher's exact test and Kaplan-Meier survival curve. A Cox proportional hazard model was used for multivariate analysis to identify the risk factors for seizure recurrence after univariate analysis. P value < 0.05 was considered significant, and all P values were two-tailed. Results95 epilepsy patients with cause unknown between 9 to 45 years old were recruited (63 in normal twice group and 32 in normal once group). The cumulated recurrence rates in continual two normal VEEG group vs one normal VEEG group were 4.8% vs 21.9% (P=0.028), 4.8% vs 25% (P=0.006) and 7.9% vs 25%(P=0.03) at 18 months, 24 months and endpoint following AEDs withdrawal and there was statistically difference between the two groups. Factors associated with increased risk were adolescent onset epilepsy (HR=2.404), history of withdrawal recurrence (HR=7.186) and abnormal VEEG (epileptic-form discharge) (HR=8.222) during or after withdrawal AEDs. The recurrence rate of each group in which abnormal VEEG vs unchanged VEEG during or after withdrawal AEDs was respectively 100% vs 4.92% (P=0.005), 80% vs 19.23%(P=0.009). ConclusionsContinual normal 24h VEEG twice before withdrawal AEDs had higher predicting value of seizure recurrence and it could guide physicians to make the withdrawal decision. Epileptic patients with adolescent onset epilepsy, history of seizure recurrence and abnormal VEEG (epileptic-form discharge) during or after withdrawal AEDs had high risk of replase, especially patients with the presence of VEEG abnormalities is associated with a high probability of seizures occurring. Discontinuate AEDs should be cautious.
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.
ObjectiveTo observe the children with idiopathic epilepsy who received AED therapy and seizure-free, withdrawal at least 1 year, and analyze the risk factors of seizure recurrence. In order to give better instructions for AED withdrawal of children with idiopathic epilepsy in pediatric department. MethodsChildren with idiopathic epilepsy who were seizure-free and had stopped AED treatment at least 1 year before the deadline of observation were collected from pediatric outpatient and inpatient department of the First Affiliated Hospital of Guangxi Medical University from January 2011 to January 2014. The following variables, derived from the case records were analyzed: sex, age at seizure onset, type of seizure, time period between the onset of the first seizure and start of treatment, number of seizures in the time period between the start of AED therapy and the last seizure, number of AEDs before remission, time period between the start of AED therapy and the last seizure, time period between the last seizure and withdrawal of AED treatment (seizure-free period, timing of AED withdrawal), time period between the start of AED withdrawal and total discontinuation(speed of withdrawal), EEG registered at the time of diagnosis, before AED withdrawal, during and after AED withdrawal, and the condition of recurrence, data analysed by multi-variate step-wise Cox regression model analysis. ResultsA total of 16(12.8%) children relapsed in a total number of 125 children with idiopathic epilepsy we collected; date evaluated by multi-variable analysis showed that the children suffering from seizure type of focal seizure, starting withdrawal after a seizure-free period of less than 3 years and with abnormal post-withdrawal EEG recording was associated with a higher risk of seizure recurrence. ConclusionsChildren with idiopathic epilepsy have a low risk of recurrence after AED withdrawal. Those who suffer from seizure type of focal seizure, start withdrawal after a seizure-free period of less than 3 years and with abnormal post-withdrawal EEG recording are associated with a higher risk of seizure recurrence.
ObjectiveThe risk factors of relapse in 133 epileptic children after withdrawal were analyzed retrospectively and provide reference for clinical withdrawal.MethodsFrom January 2017 to March 2019, 133 children with withdrawal epilepsy were selected as the study object. According to whether there was recurrence during the follow-up period, the children with epilepsy were divided into recurrence group (42 cases) and non recurrence group (91 cases). The gender, age of onset, history of trauma, frequency of seizure before treatment, EEG before drug reduction, imaging, type of medication, family history, time of reaching control, course of disease before treatment, comorbidity, multiple attack types, withdrawal speed and EEG before treatment were observed and compared between the two groups. ResultsThere were significant differences in EEG (χ2 =7.621), medication type (χ2=8.760), time to control (χ2=6.618), course before treatment (χ2=6.435), multiple seizure types (χ2=5.443) and epilepsy comorbidity (χ2=42.795) between the two groups (P < 0.05). The results of Logistic multiple regression analysis showed that the recurrence of epileptic children after drug reduction / withdrawal was correlated with abnormal EEG before drug reduction [OR=9.268, 95%CI (2.255, 38.092)], combined drug treatment [OR=3.205, 95%CI (1.159, 8.866)] and course of disease > 1 year before treatment [OR=5.363, 95%CI (1.781, 16.150)] (P < 0.05).ConclusionsIn order to reduce the possibility of recurrence of epileptic children, the treatment time of epileptic children with abnormal EEG, combined medication and long course before treatment should be prolonged properly.