Discontinuation of anticonvulsant therapy in patients with idiopathic generalized epilepsy: risk factors

Introduction. Idiopathic generalized epilepsies account for approximately 15-20% of individuals with epilepsy. However, there is no consensus on how to cancel anticonvulsant therapy in patients with these epileptic syndromes after achieving remission, and what can be considered as risk factors for relapse of seizures.

Purpose: identification of predictors of seizure recurrence after discontinuation of anticonvulsant therapy in patients with idiopathic generalized epilepsy.

Materials and methods. Retrospective analysis of seizure recurrence after discontinuation of anticonvulsant therapy in patients with idiopathic generalized epilepsy. The analysis included two hundred thirty eight patients with genetic generalized epilepsy (GGE), of which 209 (88%) patients were with idiopathic generalized epilepsy (IGE) and 29 (12%) patients with GGE. 143 (68%) patients with IGE achieved remission. An attempt to cancel anticonvulsant was made in 78 (54%) patients.

Results. Seizure recurrence was observed in 57 (73%) patients. 90% of seizure relapses occurred in the first 5 years after discontinuation of therapy, half of the relapses occurred in the first year. In group of patients with childhood absence epilepsy (CAE), therapy was discontinued in 6 patients, relapse — 0. 8/14 (57,1%) patients with juvenile absence epilepsy (JAE) had relapse after therapy discontinuation. The relapse in patients with juvenile myoclonic epilepsy (JME) was 23/25 (92%) and in group of patients with isolated generalized tonic-clinic seizure (IGTCS) was in 26/33 (78,8%).

Conclusion. Among the epileptic syndromes included in the group of idiopathic generalized epilepsies, CAE has the most favourable prognosis after discontinuation of anticonvulsant therapy, and JME has the least, with a recurrence risk of more than 90%.

Contribution. Each author made an equal contribution to the writing of the article. All co-authors are responsible for the integrity of all parts of the manuscript and approval of its final version.

Compliance with ethical standards. The study does not require the submission of the opinion of the biomedical ethics committee or other documents.

Acknowledgements. The study had no sponsorship. We express our gratitude to Alexandra Demidova for her contribution to the statistical processing of the obtained data.

Conflict of interest. The authors declare no conflict of interest.

Received: April 10, 2023
Accepted:  May 23, 2023
Published: June 30, 2023

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