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Acute withdrawal of new-generation antiepileptic drugs in epilepsy monitoring units: Safety and efficacy.

Authors:
Chien-Chen Chou Po-Tso Lin Der-Jen Yen Hsiang-Yu Yu Shang-Yeong Kwan Chien Chen Yo-Tsen Liu Yen-Cheng Shih Szu-Ying Lin

Epilepsy Behav 2021 Apr 21;117:107846. Epub 2021 Feb 21.

Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurology, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.

Introduction: Acute withdrawal of antiepileptic drugs (AEDs) is a safe and effective approach to provoking seizures in order to complete video-electroencephalogram (V-EEG) studies in a timely manner. Previous studies have focused only on withdrawal from conventional AEDs, and the effects of withdrawal from new-generation AEDs have not been extensively studied.

Materials And Methods: This study examined adult patients with drug-resistant epilepsy admitted to an epilepsy monitoring unit between 2015 and 2018. Patients were classified according to whether they received conventional AEDs (Con; n = 13) or new-generation AEDs (N-Gen; n = 26). We then compared the effects of withdrawing these two types of AEDs over a period of one week in terms of efficacy (time to complete V-EEG monitoring) and safety, including the incidence of cluster seizures (CS), focal to bilateral tonic-clonic seizures (FBTCS) and status epilepticus (SE).

Results: In both groups, approximately one week was required to complete V-EEG analysis: N-Gen group (5.6 days) and Con group (6.3 days). No differences were observed between the two groups in terms of the median number of seizures, the onset of the 1st seizure, the distribution of CS, FBTCS, or SE. Following acute withdrawal of medication, a high percentage of patients with a history of CS or FBTCS, respectively, presented CS or FBTCS.

Conclusions: We did not observe significant differences between patients taking new-generation AEDs and those taking conventional AEDs following withdrawal during V-EEG recording. In the current study, we employed a standard protocol for the rapid withdrawal of AEDs (daily dose reduction of 50%), which was sufficient for 80% of patients to complete V-EEG monitoring within one week.

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http://dx.doi.org/10.1016/j.yebeh.2021.107846DOI Listing
April 2021

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Acute withdrawal of new-generation antiepileptic drugs in epilepsy monitoring units: Safety and efficacy.

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Chien-Chen Chou Po-Tso Lin Der-Jen Yen Hsiang-Yu Yu Shang-Yeong Kwan Chien Chen Yo-Tsen Liu Yen-Cheng Shih Szu-Ying Lin

Epilepsy Behav 2021 Apr 21;117:107846. Epub 2021 Feb 21.

Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurology, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.

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