Reduction of AEDs in postsurgical patients who attain remission

Anne T. Berg, Barbara G. Vickrey, John T. Langfitt, Michael R. Sperling, Shlomo Shinnar, Carl Bazil, Thaddeus Walczak, Susan S. Spencer

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Abstract

Purpose: Little evidence guides practice regarding the reduction of antiepileptic drugs (AEDs) in individuals who achieve significant periods of remission after resective surgery. Methods: In a prospective study of 396 individuals who underwent resective surgery for intractable seizures, the impact of reducing AEDs on relapse and predictors of relapse were examined. Results: Of 301 study subjects who attained a 1-year seizure remission after surgery, 129 reduced from two to one or from one to no AEDs after achieving remission, and 162 did not reduce drugs. Ten patients who stopped all AEDs before attaining remission were excluded from analysis. In all, 114 (39%) patients relapsed: 73 (45%) of 162 in the nonreduction group and 41 (32%) of 129 in the reduction group (p = 0.02). Patients who reduced drugs were more likely to have remitted immediately after hospital discharge (p<0.0001). After adjustment for this factor, little or no apparent impact of drug reduction on the rate of relapse was noted [rate ratio (RR), 1.1; 95% CI, 0.72-1.71; p=0.64 for reducing from two to one AED, and RR, 0.85; 95% CI, 0.50-1.45; p=0.56 for reducing from one to no AEDs]. Within the 129 patients who reduced AEDs, only delayed remission after hospital discharge was significantly associated with an increased rate of relapse (RR, 2.26; 95% CI, 1.15- 4.48; p=0.02). Continued auras had a marginally significant association with relapse (RR, 2.06; p=0.07) Conclusions: Although many relapses in this cohort of postsurgical patients who achieved remission occurred in the context of reducing or completely eliminating AEDs, the risk was no higher than in those who continued AEDs. Randomized studies are needed to test the impact of drug reduction in seizure-free postsurgical patients.

Original languageEnglish (US)
Pages (from-to)64-71
Number of pages8
JournalEpilepsia
Volume47
Issue number1
DOIs
StatePublished - Jan 2006

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Anticonvulsants
Recurrence
Pharmaceutical Preparations
Seizures
Post-Traumatic Epilepsy
Epilepsy
Prospective Studies

Keywords

  • AED discontinuation
  • Epilepsy surgery
  • Relapse

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Berg, A. T., Vickrey, B. G., Langfitt, J. T., Sperling, M. R., Shinnar, S., Bazil, C., ... Spencer, S. S. (2006). Reduction of AEDs in postsurgical patients who attain remission. Epilepsia, 47(1), 64-71. https://doi.org/10.1111/j.1528-1167.2006.00371.x

Reduction of AEDs in postsurgical patients who attain remission. / Berg, Anne T.; Vickrey, Barbara G.; Langfitt, John T.; Sperling, Michael R.; Shinnar, Shlomo; Bazil, Carl; Walczak, Thaddeus; Spencer, Susan S.

In: Epilepsia, Vol. 47, No. 1, 01.2006, p. 64-71.

Research output: Contribution to journalArticle

Berg, AT, Vickrey, BG, Langfitt, JT, Sperling, MR, Shinnar, S, Bazil, C, Walczak, T & Spencer, SS 2006, 'Reduction of AEDs in postsurgical patients who attain remission', Epilepsia, vol. 47, no. 1, pp. 64-71. https://doi.org/10.1111/j.1528-1167.2006.00371.x
Berg AT, Vickrey BG, Langfitt JT, Sperling MR, Shinnar S, Bazil C et al. Reduction of AEDs in postsurgical patients who attain remission. Epilepsia. 2006 Jan;47(1):64-71. https://doi.org/10.1111/j.1528-1167.2006.00371.x
Berg, Anne T. ; Vickrey, Barbara G. ; Langfitt, John T. ; Sperling, Michael R. ; Shinnar, Shlomo ; Bazil, Carl ; Walczak, Thaddeus ; Spencer, Susan S. / Reduction of AEDs in postsurgical patients who attain remission. In: Epilepsia. 2006 ; Vol. 47, No. 1. pp. 64-71.
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abstract = "Purpose: Little evidence guides practice regarding the reduction of antiepileptic drugs (AEDs) in individuals who achieve significant periods of remission after resective surgery. Methods: In a prospective study of 396 individuals who underwent resective surgery for intractable seizures, the impact of reducing AEDs on relapse and predictors of relapse were examined. Results: Of 301 study subjects who attained a 1-year seizure remission after surgery, 129 reduced from two to one or from one to no AEDs after achieving remission, and 162 did not reduce drugs. Ten patients who stopped all AEDs before attaining remission were excluded from analysis. In all, 114 (39{\%}) patients relapsed: 73 (45{\%}) of 162 in the nonreduction group and 41 (32{\%}) of 129 in the reduction group (p = 0.02). Patients who reduced drugs were more likely to have remitted immediately after hospital discharge (p<0.0001). After adjustment for this factor, little or no apparent impact of drug reduction on the rate of relapse was noted [rate ratio (RR), 1.1; 95{\%} CI, 0.72-1.71; p=0.64 for reducing from two to one AED, and RR, 0.85; 95{\%} CI, 0.50-1.45; p=0.56 for reducing from one to no AEDs]. Within the 129 patients who reduced AEDs, only delayed remission after hospital discharge was significantly associated with an increased rate of relapse (RR, 2.26; 95{\%} CI, 1.15- 4.48; p=0.02). Continued auras had a marginally significant association with relapse (RR, 2.06; p=0.07) Conclusions: Although many relapses in this cohort of postsurgical patients who achieved remission occurred in the context of reducing or completely eliminating AEDs, the risk was no higher than in those who continued AEDs. Randomized studies are needed to test the impact of drug reduction in seizure-free postsurgical patients.",
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