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Seizure recurrence risk in persons with epilepsy undergoing antiepileptic drug tapering
Author(s) -
Kumar Sachin,
Sarangi Sudhir Chandra,
Tripathi Manjari,
Ramanujam Bhargavi,
Gupta Yogendra Kumar
Publication year - 2020
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.13183
Subject(s) - medicine , epilepsy , carbamazepine , levetiracetam , tapering , anesthesia , pediatrics , observational study , phenytoin , psychiatry , computer graphics (images) , computer science
Objectives Antiepileptic drug (AED) tapering in persons with epilepsy (PWE) after 2‐3 years of seizure freedom is still debatable because of the risk of seizure recurrence. Tapering patterns have wide variability and could impact seizure recurrence; this study aimed to find out the correlation between them. Material and Methods This prospective, observational independent assessor study enrolled PWE undergoing AED tapering in a tertiary care hospital. Data collected included demography, seizure history, AED treatment, and investigational findings. Tapering pattern was assessed based on seizure‐free period and AED dose before onset of tapering, dose reduction percentage and frequency, duration of tapering, and follow‐up. These variables were compared among the PWE with seizure recurrence and no seizure recurrence. Results Among 408 enrolled PWE, 181 were on AED monotherapy: levetiracetam (73), valproate (45), carbamazepine (44), phenytoin (16), and clobazam (3). With a minimum 19 (maximum 41 months) follow‐up, seizure recurrence was reported in 119 (29.2%) PWE. The seizure recurrence was not significantly different in‐between mono and polytherapy groups; however, among monotherapy groups seizure recurrence was significantly higher ( P = .023) in valproate (35.5%) followed by levetiracetam (28.8%) group. Parameters having significant association with seizure recurrence were duration of epilepsy ( P = .03), frequency of seizures before control ( P = .002), history of previously failed tapering ( P = .04), and history of smoking/alcoholic/tobacco intake ( P = .003). Conclusions There is a wide variation in AEDs tapering pattern and seizure recurrence risk can be minimized by considering the risk factors like history of smoking/alcoholic/tobacco, longer duration of epilepsy, frequency of seizures before control, and previously failed tapering.