Rapid versus slow withdrawal of antiepileptic drugs

摘要: Background The ideal objective of treating a person with epilepsy is to induce remission by usage antiepileptic drugs (AEDs) and withdraw the AEDs without causing seizure recurrence. Prolonged may have long-term side effects. Hence when in (free seizures for some time) it logical attempt discontinue medication. The timing withdrawal mode arise while contemplating AEDs. This review proposes examine evidence rate (whether rapid or slow tapering) its effect on recurrence seizure. also examines variables such as age onset, types, presence neurological deficits, mental subnormality, aetiology epilepsy, type AED, EEG findings duration freedom risk two tapering regimens. Objectives (1) To quantify after (taper period three months less) more than months) discontinuation adults who are remission. (2) children (3) assess which modify recurrence. Search methods We searched Cochrane Epilepsy Group's Specialized Register (August 2005), Central Controlled Trials (CENTRAL) (The Library Issue 3, MEDLINE (1966 September 2004) cross-references from identified studies. No language restrictions were imposed. Selection criteria Randomized controlled trials that evaluate manner varying periods control patients epilepsy. Data collection analysis Both authors independently assessed inclusion extracted data. outcomes included relapse (i.e. percentage experiencing AED); time following withdrawal; occurrence status epilepticus; mortality; morbidity due injuries, fractures, aspiration pneumonia; quality life (if validated scale). Main results One trial weak methodology involving 149 was mean onset four years, 11 years at starting taper. taper group (six weeks) recruited 81 participants (nine 68 participants, out whom 5 lost follow up even before began respectively. number free groups 40 44 respectively end one year (OR 0.53, 95% CI 0.27 1.03); 30 29 0.79, 0.41 1.53); 24 14 1.62, 0.76 3.46); 18 8 2.14, 0.87 5.3); 10 6 five 1.46, 0.5 4.23). Authors' conclusions In view methodological deficiencies small sample size, solitary study identified, we cannot derive any reliable conclusions regarding optimal Further studies needed well investigate effects aetiology, retardation, abnormalities, deficits other co-morbidities tapering.