A Cohort Study Of Relapse After Withdrawal From Patients With Epilepsy During 2 Years Of Epilepsy Remission

BackgroundFor patients with epilepsy,antiepileptic drugs are the preferred treatment option,and70%of patients with reasonable treatment of AEDs can control the symptoms of seizures to enter the remission phase of epilepsy.In order to eliminate the side effects of AEDs and reduce the economic burden and mental stress of epilepsy patients,most patients who enter the epilepsy remission phase will face the problem of AEDs withdrawal.At present,there are many researches on the relapse rate and the risk factors related to relapse after epilepsy withdrawal at home and abroad,but these studies have not reached a consensus,and epilepsy patients and clinicians also lack the relevant guidelines for AEDs withdrawal.ObjectivesThis study evaluated the recurrence rate,the resolve rate,peak recurrence period,and risk factors associated with recurrence in epilepsy patients after 2 years of epilepsy remission drug withdrawal,thereby providing a certain measure of the risk/return ratio for assessing withdrawal AEDs for patients entering epileptic remission.MethodsThis study was performed at the department of neurology,Second Affiliated Hospital of Xinxiang Medical University from September 1990 to June 2016.The diagnosis was clear.After the AEDs were applied,they experienced two or more years of remission,and all of them had withdrawal requirements and started to reduce.Discontinued patients with epilepsy were the subjects of the study and were followed up for at least 2 years or more.Usingχ~2 test,Kaplan-Meier survival analysis and multi-factor COX regression analysis,the clinical data collected from 423 patients were statistically analyzed.ResultsBy the end of the follow-up period,a total of 423 patients were successfully followed up and participated in statistics.Among them,304(71.9%)relapsed,119(28.1%)were not relapsed,and 74(17.5%)were cured;the peak of relapse was withdrawal drug.Within 3 months after.In general clinical data,compared with the non-recurrent group,the relapsed group compared with the non-recurrent group.The relapsed factors affecting epilepsy patients are the onset age,seizure type,AEDs drug type,remission period,pre-decrease electroencephalogram(EEG)results(P<0.05).Analysis of the relationship between related factors and relapse shows that the age of onset,seizure frequency,seizure type,AEDs medication type,duration of control,pre-reduced EEG results,and epilepsy duration are the seven factors that affect relapse after withdrawal from epilepsy patients.(P<0.05).The independent risk factors for epilepsy recurrence after discontinuation showed that the onset was large(HR:1.68,95%CI:1.32-2.14,P=0.00)and the frequency of seizures was high(HR:1.53,95%CI:1.15-2.04,P=0.00),AEDs multidrug combination therapy(HR:1.62,95%CI:1.24-2.12,P=0.00)and long control time(HR:1.57,95%CI:1.22-2.00,P=0.00)is an independent risk factor for epileptic recurrence after withdrawal medication.Conclusions1.The cumulative recurrence rate of patients was 71.9%,the resolve rate was17.5%.The peak of recurrence was within 3 months after the AEDs was stopped.2.Patients with characteristics of partial onset,short remission period,severe EEG anomaly before and after reduction of medication,and long duration of disease are prone to relapse.3.Patients with features such as age of onset,high frequency of attacks,multi-drug combination therapy,and long control time should be careful to withdrawal AEDs.