Cochrane: Epilepsy
is a disorder where recurrent seizures are caused by abnormal
electrical discharges in the brain. Antiepileptic drugs (AEDs) are
commonly used to prevent these seizures but have long-term side effects.
When in remission (seizure free), it may be best to stop using the
drugs but the right time to withdraw them is still unclear.
We searched electronic databases in June 2014, adding to the trials included in a previous version of this review. Five trials were added to our analysis, comprising 924 epileptic children (all below 16 years old) who were randomly assigned to either early removal of AEDs (before completing two years without seizures); or late withdrawal of AEDs (after completing two years without seizures). Considering all evidence, we found that stopping AED intake before completing two years without seizures increases the risk of seizure relapse by around 34%. This percentage is increased if the child has partial seizures (if the electrical burst only involves a part of the brain, resulting mainly in localized symptoms); or an abnormal electroencephalogram (EEG) record (unusual patterns of electrical activity in the brain). Other factors that might be related to a higher relapse rate are: age below two years or above 10 years when epilepsy started; history of status epilepticus (convulsions longer than 30 minutes); an IQ lower than 70; and high frequency of seizures before and during treatment. Overall, the included trials provided a moderate quality of evidence.
The review of trials found that there is evidence to support waiting at least two years or more seizure free before discontinuing AEDs in children, especially if they had partial seizures or abnormal EEG.
There is not enough evidence to show the best time to withdraw antiepileptic drugs in adults with epilepsy who are free of seizures.
There is not enough evidence that demonstrates the optimal time to remove antiepileptic drugs in people (children or adults) with generalised seizures (if the electrical discharges affect the whole brain, causing global symptoms).
More research is needed, particularly involving adults and those with generalised seizure types.
We searched electronic databases in June 2014, adding to the trials included in a previous version of this review. Five trials were added to our analysis, comprising 924 epileptic children (all below 16 years old) who were randomly assigned to either early removal of AEDs (before completing two years without seizures); or late withdrawal of AEDs (after completing two years without seizures). Considering all evidence, we found that stopping AED intake before completing two years without seizures increases the risk of seizure relapse by around 34%. This percentage is increased if the child has partial seizures (if the electrical burst only involves a part of the brain, resulting mainly in localized symptoms); or an abnormal electroencephalogram (EEG) record (unusual patterns of electrical activity in the brain). Other factors that might be related to a higher relapse rate are: age below two years or above 10 years when epilepsy started; history of status epilepticus (convulsions longer than 30 minutes); an IQ lower than 70; and high frequency of seizures before and during treatment. Overall, the included trials provided a moderate quality of evidence.
The review of trials found that there is evidence to support waiting at least two years or more seizure free before discontinuing AEDs in children, especially if they had partial seizures or abnormal EEG.
There is not enough evidence to show the best time to withdraw antiepileptic drugs in adults with epilepsy who are free of seizures.
There is not enough evidence that demonstrates the optimal time to remove antiepileptic drugs in people (children or adults) with generalised seizures (if the electrical discharges affect the whole brain, causing global symptoms).
More research is needed, particularly involving adults and those with generalised seizure types.
Authors' conclusions:
There is evidence to support
waiting for at least two seizure-free years before discontinuing AEDs in
children, particularly if individuals have an abnormal EEG or partial
seizures, or both. There is insufficient evidence to establish when to
withdraw AEDs in children with generalised seizures. There is no
evidence to guide the timing of withdrawal of AEDs in seizure-free
adults. Further high-quality randomised controlled trials are needed,
particularly recruiting adults and recruiting those with generalised
seizure types, to identify the optimal timing of AED withdrawal and risk factors predictive of relapse.