Nawroty napadów i długoterminowe wyniki po drugiej próbie odstawienia leku przeciwpadaczkowego u pacjentów z epilepsją: badanie kohortowe wsteczne
Seizure Recurrence and Long-Term Outcomes After a Second Antiseizure Medication Withdrawal Attempt in Patients with Epilepsy: A Retrospective Cohort Study
W skrócie
Badanie dotyczyło 45 pacjentów z epilepsją, u których nawrócił się napady po pierwszej próbie odstawienia leku, którzy wznowili leczenie i ponownie osiągnęli kontrolę napadów, a następnie podjęli drugą próbę odstawienia. Stwierdzono, że u ponad połowy pacjentów (56%) doszło do nawrotu napadów, głównie w ciągu roku od rozpoczęcia zmniejszania dawki, ale większość z nich ostatecznie znowu osiągnęła wolność od napadów. Płeć żeńska była związana z wyższym ryzykiem nawrotu, natomiast przerwa między próbami odstawienia i czas bez napadów nie miały istotnego wpływu na wynik.
Oryginalny abstract (angielski)
OBJECTIVE: Evidence on a second antiseizure medication (ASM) withdrawal attempt after relapse following a first attempt is limited. We evaluated seizure recurrence, long-term outcomes, and factors associated with recurrence in this selected population. METHODS: This single-center retrospective cohort included 45 patients who relapsed after a first ASM withdrawal, restarted treatment and regained seizure control, and subsequently initiated a second withdrawal attempt. Time to recurrence was calculated from the initiation of tapering, and recurrences during tapering were counted as events. Kaplan-Meier analysis was applied to estimate recurrence. A prespecified Cox model was used to evaluate sex, inter-withdrawal interval, and seizure-free duration. A favorable outcome was defined as seizure freedom during the final year of follow-up. Final-year seizure status was assessed exploratorily because only 7 patients had an unfavorable outcome. RESULTS: Median follow-up was 66.4 months (range 12.0-226.2). Twenty-five patients (55.6%) had recurrence, including 13 (52.0% of recurrences) during tapering; 80.0% of recurrences occurred within 1 year. In the adjusted model, female sex was associated with recurrence (hazard ratio [HR], 2.867; 95% confidence interval [CI], 1.223-6.722; P=0.015), whereas inter-withdrawal interval (per year: HR, 0.748; 95% CI, 0.524-1.067; P=0.109) and seizure-free duration (per year: HR, 0.815; 95% CI, 0.528-1.258; P = 0.355) were not. Thirty-eight patients (84.4%) achieved seizure freedom during the final year. Of 25 patients with recurrence, 18 (72.0%) were seizure-free during the final year, and only one developed drug-resistant epilepsy. CONCLUSION: Recurrence was common after a second ASM withdrawal attempt in this small, predominantly pediatric-onset cohort, but most patients who relapsed later regained seizure control. Female sex was associated with recurrence, whereas no independent association was detected for either the inter-withdrawal interval or the seizure-free duration before the second attempt. These findings are exploratory and do not establish a specific timing threshold for a second withdrawal attempt.