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It is only for medical professionals to read for reference.
It is recommended in two parts: adults and children.
It is worth a look! The essence of this article: 1.
Recommendations for discontinuation of antiepileptic drugs without seizures are listed separately for adults (≥18 years old) and children (<18 years old), because there are biological differences between adults and children with epilepsy
.
2.
The adult recommendation statement has 2 Level A, 3 Level B, and 2 Level
C.
Based on available evidence, adults who have been seizure-free for at least 2 years should discuss the risks and benefits of discontinuing antiepileptic drugs
.
It is unclear whether EEG and imaging can guide drug discontinuation in adults with epilepsy
.
Physicians should discuss and inform patients and their families in many ways about drug discontinuation
.
3.
There are 1 Level A and 6 Level B in the child recommendation statement
.
Based on the available evidence, children who have been seizure-free for at least 18-24 months should discuss the risks and benefits of discontinuing antiepileptic drugs
.
Antiepileptic drugs should be discontinued in children and an EEG should be performed
.
In children, discontinuation should not exceed a 25% reduction every 10–14 days
.
Physicians must consider the natural history of a particular electro-clinical syndrome
.
A patient with epilepsy taking antiepileptic drugs, if he/she has not had seizures for at least 1-2 years, is there a risk of epilepsy recurrence if he/she stops antiepileptic drugs? Does discontinuation of antiepileptic drugs increase the risk of status epilepticus? This kind of soul torture, the doctors in God may have been asked thousands of times
.
The good news is that the American Academy of Neurology recently released the "Practical Guidelines for Discontinuing Antiepileptic Drugs in Patients Without Seizures", which specifically answers the above-mentioned soul torture.
Let's take a look at the 14 recommendations of the guideline (7 for adults + 7 for children).
) it
.
Before reading, understand the recommended level of the American Academy of Neurology guidelines [1], and the reading effect will be better
.
The recommended levels for this guideline are given by a modified Delphi method, ranging from Level A to Level C (Table 1) [1]
.
Table 1 American Academy of Neurology guideline recommendation level 14 recommended adult version 7 recommendation statements (Note: adult refers to age ≥ 18 years) [2], including 2 Level A, 3 Level B, and 2 Level
C.
Recommendation Statement 1a: In adults with epilepsy who have been seizure-free for at least 2 years, clinicians, patients, and caregivers should discuss the risks and benefits of discontinuing antiepileptic drugs.
In particular, the following should be included and documented: 1) Discontinuation of antiepileptic drugs There may be a higher risk of epilepsy recurrence; 2) If epilepsy recurs during or after discontinuation of the antiepileptic drug, the antiepileptic drug is less likely to be ineffective for the patient
.
(Level B) Recommended Statement 1b: When discussing with patients discontinuing or continuing antiepileptic drugs, clinicians may consider patient characteristics and preferences since there is no statistically significant evidence to support a better decision
.
(Level C) Recommendation Statement 1c: Medical notification must include: There is no strong evidence of an association between antiepileptic drug discontinuation and risk of mortality and status epilepticus
.
However, the evidence does not rule out these risks
.
(Level A) Recommendation Statement 1d: Clinicians should inform patients that recurrent epilepsy puts patients at risk of status epilepticus and death (Level B), although available data do not suggest status epilepticus or status epilepticus after discontinuation of antiepileptic drugs Increased risk of death
.
Recommendation Statement 1e: Clinicians must explore factors that affect patients' quality of life as part of a shared decision to discontinue antiepileptic drugs
.
(Level A) Recommendation Statement 1f: Clinicians should inform patients without seizures that it is not known whether EEG or imaging studies can guide drug discontinuation
.
(Level B) Recommendation Statement 2: Clinicians can inform patients that the risk of seizure recurrence is uncertain after discontinuation of antiepileptic drugs in patients who have undergone epilepsy surgery and are seizure-free due to lack of evidence
.
(Level C) 7 recommended statements for children (Note: children refer to age <18 years old) [2], 1 Level A, 6 Level
B.
Recommendation 3a: Children who are seizure-free for at least 18-24 months and who do not have an electroclinical syndrome should discuss the risks and benefits of discontinuing antiepileptic drugs
.
In particular, it should be included and documented that there is a small chance that antiepileptic drugs will not be effective if seizures recur during or after drug withdrawal
.
(Level B) Recommendation 3b: Clinicians should inform the child and his family that antiepileptic drug discontinuation may be considered
.
Because stopping antiepileptic drugs did not increase the risk of epilepsy recurrence
.
(Level B) Recommended Statement 3c: Clinicians should inform the child and his family that recurrent epilepsy puts the patient at risk for status epilepticus and death (Level B), although available data do not suggest that following antiepileptic drug discontinuation Increased risk of status epilepticus or death
.
Recommendation Statement 3d: Clinicians should explore factors affecting children's quality of life as part of a shared decision to discontinue antiepileptic drugs
.
(Level B) Recommendation Statement 3e: Children who have been seizure-free for at least 18-24 months should have an EEG if the clinician, child, and family agree that antiepileptic drug discontinuation should be considered
.
(Level B) Recommendation Statement 3f: Children who have been seizure-free for at least 18-24 months and wish to consider discontinuation of antiepileptic drugs if agreed by clinician, child, and family, should be considered if EEG does not show epileptiform activity Discontinue antiepileptic drugs by no more than a 25% reduction every 10–14 days
.
(Level B) Recommendation Statement 3g: When counseling children about antiepileptic drug discontinuation, clinicians must consider the known natural history of the particular electro-clinical syndrome
.
(Level A) This information should also be understood This guideline is an update of the American Academy of Neurology's 1996 practice guideline
.
Although this edition of the guideline reviewed studies published between January 1991 and March 2020 in detail, none of the studies published after April 2013 actually met the guideline inclusion criteria
.
From this we can see that the guidelines summarize the most appropriate recommendations based on the available evidence for the practical clinical question of how to discontinue antiepileptic drugs in patients without seizures
.
There are few recommendations for Level A, and decisions need to be fully discussed with patients and their families
.
The guidelines are more inclined to recommend that physicians interpret and inform patients and their families about the clinical evidence currently obtained, and patients and families are also co-participants in clinical decision-making
.
The guidelines give some future research directions, such as [2]: 1.
Are there any auxiliary examination prompts for discontinuation of antiepileptic drugs in patients without seizures? 2.
Is there a specific recommendation for the speed of drug withdrawal? 3.
Are there other risks for the patient if epilepsy recurs after discontinuation of antiepileptic drugs? When should I consider stopping the drug for the second time? 4.
Research data on driving, discontinuation of antiepileptic drugs, and safety needs
.
This soul torture has not yet been answered perfectly, and high-quality research still needs to be further strengthened
.
Reference source: [1]https:// D,Pargeon K,Pack A,et al.
Antiseizure Medication Withdrawal in Seizure-Free Patients:Practice Advisory Update Summary:Report of the AAN Guideline Subcommittee.
Neurology.
2021;97(23):1072-1081.
In order to know more about readers' thoughts on our channel, a special A small voting activity, I hope to make better content according to everyone's ideas in the future, refill~
It is recommended in two parts: adults and children.
It is worth a look! The essence of this article: 1.
Recommendations for discontinuation of antiepileptic drugs without seizures are listed separately for adults (≥18 years old) and children (<18 years old), because there are biological differences between adults and children with epilepsy
.
2.
The adult recommendation statement has 2 Level A, 3 Level B, and 2 Level
C.
Based on available evidence, adults who have been seizure-free for at least 2 years should discuss the risks and benefits of discontinuing antiepileptic drugs
.
It is unclear whether EEG and imaging can guide drug discontinuation in adults with epilepsy
.
Physicians should discuss and inform patients and their families in many ways about drug discontinuation
.
3.
There are 1 Level A and 6 Level B in the child recommendation statement
.
Based on the available evidence, children who have been seizure-free for at least 18-24 months should discuss the risks and benefits of discontinuing antiepileptic drugs
.
Antiepileptic drugs should be discontinued in children and an EEG should be performed
.
In children, discontinuation should not exceed a 25% reduction every 10–14 days
.
Physicians must consider the natural history of a particular electro-clinical syndrome
.
A patient with epilepsy taking antiepileptic drugs, if he/she has not had seizures for at least 1-2 years, is there a risk of epilepsy recurrence if he/she stops antiepileptic drugs? Does discontinuation of antiepileptic drugs increase the risk of status epilepticus? This kind of soul torture, the doctors in God may have been asked thousands of times
.
The good news is that the American Academy of Neurology recently released the "Practical Guidelines for Discontinuing Antiepileptic Drugs in Patients Without Seizures", which specifically answers the above-mentioned soul torture.
Let's take a look at the 14 recommendations of the guideline (7 for adults + 7 for children).
) it
.
Before reading, understand the recommended level of the American Academy of Neurology guidelines [1], and the reading effect will be better
.
The recommended levels for this guideline are given by a modified Delphi method, ranging from Level A to Level C (Table 1) [1]
.
Table 1 American Academy of Neurology guideline recommendation level 14 recommended adult version 7 recommendation statements (Note: adult refers to age ≥ 18 years) [2], including 2 Level A, 3 Level B, and 2 Level
C.
Recommendation Statement 1a: In adults with epilepsy who have been seizure-free for at least 2 years, clinicians, patients, and caregivers should discuss the risks and benefits of discontinuing antiepileptic drugs.
In particular, the following should be included and documented: 1) Discontinuation of antiepileptic drugs There may be a higher risk of epilepsy recurrence; 2) If epilepsy recurs during or after discontinuation of the antiepileptic drug, the antiepileptic drug is less likely to be ineffective for the patient
.
(Level B) Recommended Statement 1b: When discussing with patients discontinuing or continuing antiepileptic drugs, clinicians may consider patient characteristics and preferences since there is no statistically significant evidence to support a better decision
.
(Level C) Recommendation Statement 1c: Medical notification must include: There is no strong evidence of an association between antiepileptic drug discontinuation and risk of mortality and status epilepticus
.
However, the evidence does not rule out these risks
.
(Level A) Recommendation Statement 1d: Clinicians should inform patients that recurrent epilepsy puts patients at risk of status epilepticus and death (Level B), although available data do not suggest status epilepticus or status epilepticus after discontinuation of antiepileptic drugs Increased risk of death
.
Recommendation Statement 1e: Clinicians must explore factors that affect patients' quality of life as part of a shared decision to discontinue antiepileptic drugs
.
(Level A) Recommendation Statement 1f: Clinicians should inform patients without seizures that it is not known whether EEG or imaging studies can guide drug discontinuation
.
(Level B) Recommendation Statement 2: Clinicians can inform patients that the risk of seizure recurrence is uncertain after discontinuation of antiepileptic drugs in patients who have undergone epilepsy surgery and are seizure-free due to lack of evidence
.
(Level C) 7 recommended statements for children (Note: children refer to age <18 years old) [2], 1 Level A, 6 Level
B.
Recommendation 3a: Children who are seizure-free for at least 18-24 months and who do not have an electroclinical syndrome should discuss the risks and benefits of discontinuing antiepileptic drugs
.
In particular, it should be included and documented that there is a small chance that antiepileptic drugs will not be effective if seizures recur during or after drug withdrawal
.
(Level B) Recommendation 3b: Clinicians should inform the child and his family that antiepileptic drug discontinuation may be considered
.
Because stopping antiepileptic drugs did not increase the risk of epilepsy recurrence
.
(Level B) Recommended Statement 3c: Clinicians should inform the child and his family that recurrent epilepsy puts the patient at risk for status epilepticus and death (Level B), although available data do not suggest that following antiepileptic drug discontinuation Increased risk of status epilepticus or death
.
Recommendation Statement 3d: Clinicians should explore factors affecting children's quality of life as part of a shared decision to discontinue antiepileptic drugs
.
(Level B) Recommendation Statement 3e: Children who have been seizure-free for at least 18-24 months should have an EEG if the clinician, child, and family agree that antiepileptic drug discontinuation should be considered
.
(Level B) Recommendation Statement 3f: Children who have been seizure-free for at least 18-24 months and wish to consider discontinuation of antiepileptic drugs if agreed by clinician, child, and family, should be considered if EEG does not show epileptiform activity Discontinue antiepileptic drugs by no more than a 25% reduction every 10–14 days
.
(Level B) Recommendation Statement 3g: When counseling children about antiepileptic drug discontinuation, clinicians must consider the known natural history of the particular electro-clinical syndrome
.
(Level A) This information should also be understood This guideline is an update of the American Academy of Neurology's 1996 practice guideline
.
Although this edition of the guideline reviewed studies published between January 1991 and March 2020 in detail, none of the studies published after April 2013 actually met the guideline inclusion criteria
.
From this we can see that the guidelines summarize the most appropriate recommendations based on the available evidence for the practical clinical question of how to discontinue antiepileptic drugs in patients without seizures
.
There are few recommendations for Level A, and decisions need to be fully discussed with patients and their families
.
The guidelines are more inclined to recommend that physicians interpret and inform patients and their families about the clinical evidence currently obtained, and patients and families are also co-participants in clinical decision-making
.
The guidelines give some future research directions, such as [2]: 1.
Are there any auxiliary examination prompts for discontinuation of antiepileptic drugs in patients without seizures? 2.
Is there a specific recommendation for the speed of drug withdrawal? 3.
Are there other risks for the patient if epilepsy recurs after discontinuation of antiepileptic drugs? When should I consider stopping the drug for the second time? 4.
Research data on driving, discontinuation of antiepileptic drugs, and safety needs
.
This soul torture has not yet been answered perfectly, and high-quality research still needs to be further strengthened
.
Reference source: [1]https:// D,Pargeon K,Pack A,et al.
Antiseizure Medication Withdrawal in Seizure-Free Patients:Practice Advisory Update Summary:Report of the AAN Guideline Subcommittee.
Neurology.
2021;97(23):1072-1081.
In order to know more about readers' thoughts on our channel, a special A small voting activity, I hope to make better content according to everyone's ideas in the future, refill~
