التفاصيل البيبلوغرافية
| العنوان: |
Variation in seizure risk increases from antiseizure medication withdrawal among patients with well-controlled epilepsy: a pooled analysis |
| المؤلفون: |
Terman, Samuel W, Slinger, Geertruida, Koek, Adriana, Skvarce, Jeremy, Springer, Mellanie V, Ziobro, Julie M, Burke, James F, Otte, Willem M, Thijs, Roland D, Lossius, Morten I, Marson, Anthony G, Bonnett, Laura J, Braun, Kees Pj |
| المساهمون: |
Projectafdeling KIND, Neurologen, Brain |
| سنة النشر: |
2024 |
| مصطلحات موضوعية: |
antiseizure medications, discontinuation, epilepsy, risk prediction, Clinical Neurology, Neurology, Journal Article |
| الوصف: |
Objective: Guidelines suggest considering antiseizure medication (ASM) discontinuation in seizure-free patients with epilepsy. Past work has poorly explored how discontinuation effects vary between patients. We evaluated (1) what factors modify the influence of discontinuation on seizure risk; and (2) the range of seizure risk increase due to discontinuation across low- versus high-risk patients. Methods: We pooled three datasets including seizure-free patients who did and did not discontinue ASMs. We conducted time-to-first-seizure analyses. First, we evaluated what individual patient factors modified the relative effect of ASM discontinuation on seizure risk via interaction terms. Then, we assessed the distribution of 2-year risk increase as predicted by our adjusted logistic regressions. Results: We included 1626 patients, of whom 678 (42%) planned to discontinue all ASMs. The mean predicted 2-year seizure risk was 43% [95% confidence interval (CI) 39%–46%] for discontinuation versus 21% (95% CI 19%–24%) for continuation. The mean 2-year absolute seizure risk increase was 21% (95% CI 18%–26%). No individual interaction term was significant after correcting for multiple comparisons. The median [interquartile range (IQR)] risk increase across patients was 19% (IQR 14%–24%; range 7%–37%). Results were unchanged when restricting analyses to only the two RCTs. Significance: No single patient factor significantly modified the influence of discontinuation on seizure risk, although we captured how absolute risk increases change for patients that are at low versus high risk. Patients should likely continue ASMs if even a 7% 2-year increase in the chance of any more seizures would be too much and should likely discontinue ASMs if even a 37% risk increase would be too little. In between these extremes, individualized risk calculation and a careful understanding of patient preferences are critical. Future work will further develop a two-armed individualized seizure risk calculator and contextualize seizure risk ... |
| نوع الوثيقة: |
article in journal/newspaper |
| وصف الملف: |
application/pdf |
| اللغة: |
English |
| تدمد: |
2470-9239 |
| العلاقة: |
https://dspace.library.uu.nl/handle/1874/450673Test |
| الإتاحة: |
https://dspace.library.uu.nl/handle/1874/450673Test |
| حقوق: |
info:eu-repo/semantics/OpenAccess |
| رقم الانضمام: |
edsbas.236C58DD |
| قاعدة البيانات: |
BASE |
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