When to Start and When to Stop AEDs
- سال انتشار: 1398
- محل انتشار: شانزدهمین کنگره بین المللی صرع
- کد COI اختصاصی: EPILEPSEMED16_064
- زبان مقاله: انگلیسی
- تعداد مشاهده: 394
نویسندگان
Epileptologist
چکیده
A large body of evidence has developed in recent years, allowing a more accurate estimate for seizure recurrence risk after occurring of new-onset seizure, and for stopping antiepileptic drugs therapy (AEDs) when the seizures have been controlled. In decision making for the start of AED treatment after a first seizure, a neurologist should respond to many questions, including: Is the seizure provoked or unprovoked Is the seizure associated with an epileptic syndrome or not Therefore, it is necessary to know the definitions, such as acute symptomatic seizures, remote symptomatic seizures, progressive symptomatic seizures, and more. It is evident that about 10% of the population will have a seizure at some time in their lives, but less than half of these patients will have multiple seizures. When deciding whether to start AEDs, the parameters like the recurrence rate estimation, consequences of having a second seizure, the efficacy of medications in preventing future seizures, the potential toxicity of antiepileptic drugs, and patient values and preferences should be considered. According to previous data, the risk of seizure recurrence after an unprovoked seizure increases in a specific clinical and electrophysiological setting such as prior brain lesions, EEG with epileptiform abnormalities, significant brain imaging abnormalities, and nocturnal seizures. It seems that when the patient has these items, it is necessary to start the AED treatment. For the AED discontinuation, we know that about 70% of patients with recent-onset epilepsy achieve seizure freedom with adequate antiepileptic drug treatment. For these patients, the questions are that whether, when, and how the therapy can be discontinued. The Italian League against Epilepsy has issued evidence-based guidelines to help physicians in their decision to withdraw or withhold antiepileptic drugs in patients with a prolonged period of seizure freedom. For this purpose, the following items should be considered: the duration of the seizure remission period before starting AED discontinuation, the presence of specific risk factors of relapse, the specific types of epileptic syndromes, the evaluation of the general conditions of life of a given patient (emotional state, job, driving, and other daily activities), and the possible age-related differences. It seems that some situations increase the chance for recurrence seizures after AED withdrawal such as abnormal EEG, documented brain insults (focal brain abnormalities and intellectual decline), focal seizures, older age at epilepsy onset, positive FH of epilepsy, history of FC,and known epilepsy syndrome. Some of these factors look stronger than others and nevertheless, patients should not be encouraged to withhold treatment unless a combination of two or more of these factors is present.It seems that the start and withdrawal of AED are still challenging conditions, and some of the situations are vague and should be evaluated in future researches.کلیدواژه ها
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