Study supports safety of epilepsy medication withdrawal prior to video-EEGs

WASHINGTON – Rapidly withdrawing antiepileptic medications in patients with epilepsy before being evaluated with video-electroencephalographic monitoring was safe, with no deaths or serious morbidity, in a prospective study, Dr. Syed Rizvi reported at the annual meeting of the American Epilepsy Society.

Video-electroencephalographic monitoring (VEM) also reliably helped to plan treatment, including surgery, and outcomes were "excellent," Dr. Rizvi of the department of neurology at the University of Saskatchewan, Saskatoon, Canada, said at a press briefing during the meeting.

The literature on whether it is safe and effective to rapidly withdraw antiepileptic drugs during VEM is sparse, he noted.

In 158 patients who had been admitted for VEM to the university’s epilepsy monitoring unit during a 5-year period, antiepileptic drugs (AEDs), except for phenobarbital, were rapidly withdrawn in patients who had no history of status epilepticus. The patients also underwent supervised overnight sleep deprivation. Rapid withdrawal was performed by titrating AEDs to half-dose on admission and then discontinuing them at 24 hours. In cases in which there was a history of status epilepticus or in patients taking phenobarbital or high doses of benzodiazepines, AEDs were tapered by 25% of the initial dose and ultimately discontinued.

The patients had had a mean of almost 11 seizures in the month before VEM, and 70% of patients were on three or more AEDs. Their mean age was 37 years, and they had had epilepsy for a mean of 16 years (mean age of onset was 20.5 years).

About 5% of patients had complications, which were mostly minor, including musculoskeletal pain secondary to seizure activity. During the month after testing, four (2.5%) patients were admitted to the emergency department for seizure clustering, but none were admitted to the intensive care unit. There were no deaths.

About 90% of the patients were diagnosed on the basis of VEM results, "a high diagnostic yield," Dr. Rizvi said. Habitual seizures were detected in 107 patients and psychogenic nonepileptic seizures were diagnosed in 36 patients; in 15 patients (9.5%), no events were recorded during VEM.

Almost 33% – 52 of the 158 – patients had epilepsy surgery, based on the results. Of those patients who had surgery, almost 90% achieved an excellent outcome (Engel Class I or II status) at 24 months, he said, noting that these patients were "virtually seizure free" or had nondebilitating seizures.

Video-EEG monitoring was "highly effective. It’s a useful adjunct in decision making. It can help in deciding which patients are suitable for surgery" in the "appropriate context," with supervision by a team of epileptologists, nurses, and EEG technologists, Dr. Rizvi said during the press briefing. He said that he and his coinvestigators hope to expand the study to include elderly and pediatric patients.

The study was not funded. Dr. Rizvi, a senior neurology resident at the university, had no disclosures.

[email protected]

WASHINGTON – Rapidly withdrawing antiepileptic medications in patients with epilepsy before being evaluated with video-electroencephalographic monitoring was safe, with no deaths or serious morbidity, in a prospective study, Dr. Syed Rizvi reported at the annual meeting of the American Epilepsy Society.

Video-electroencephalographic monitoring (VEM) also reliably helped to plan treatment, including surgery, and outcomes were "excellent," Dr. Rizvi of the department of neurology at the University of Saskatchewan, Saskatoon, Canada, said at a press briefing during the meeting.

The literature on whether it is safe and effective to rapidly withdraw antiepileptic drugs during VEM is sparse, he noted.

In 158 patients who had been admitted for VEM to the university’s epilepsy monitoring unit during a 5-year period, antiepileptic drugs (AEDs), except for phenobarbital, were rapidly withdrawn in patients who had no history of status epilepticus. The patients also underwent supervised overnight sleep deprivation. Rapid withdrawal was performed by titrating AEDs to half-dose on admission and then discontinuing them at 24 hours. In cases in which there was a history of status epilepticus or in patients taking phenobarbital or high doses of benzodiazepines, AEDs were tapered by 25% of the initial dose and ultimately discontinued.

The patients had had a mean of almost 11 seizures in the month before VEM, and 70% of patients were on three or more AEDs. Their mean age was 37 years, and they had had epilepsy for a mean of 16 years (mean age of onset was 20.5 years).

About 5% of patients had complications, which were mostly minor, including musculoskeletal pain secondary to seizure activity. During the month after testing, four (2.5%) patients were admitted to the emergency department for seizure clustering, but none were admitted to the intensive care unit. There were no deaths.

About 90% of the patients were diagnosed on the basis of VEM results, "a high diagnostic yield," Dr. Rizvi said. Habitual seizures were detected in 107 patients and psychogenic nonepileptic seizures were diagnosed in 36 patients; in 15 patients (9.5%), no events were recorded during VEM.

Almost 33% – 52 of the 158 – patients had epilepsy surgery, based on the results. Of those patients who had surgery, almost 90% achieved an excellent outcome (Engel Class I or II status) at 24 months, he said, noting that these patients were "virtually seizure free" or had nondebilitating seizures.

Video-EEG monitoring was "highly effective. It’s a useful adjunct in decision making. It can help in deciding which patients are suitable for surgery" in the "appropriate context," with supervision by a team of epileptologists, nurses, and EEG technologists, Dr. Rizvi said during the press briefing. He said that he and his coinvestigators hope to expand the study to include elderly and pediatric patients.

The study was not funded. Dr. Rizvi, a senior neurology resident at the university, had no disclosures.

[email protected]

WASHINGTON – Rapidly withdrawing antiepileptic medications in patients with epilepsy before being evaluated with video-electroencephalographic monitoring was safe, with no deaths or serious morbidity, in a prospective study, Dr. Syed Rizvi reported at the annual meeting of the American Epilepsy Society.

Video-electroencephalographic monitoring (VEM) also reliably helped to plan treatment, including surgery, and outcomes were "excellent," Dr. Rizvi of the department of neurology at the University of Saskatchewan, Saskatoon, Canada, said at a press briefing during the meeting.

The literature on whether it is safe and effective to rapidly withdraw antiepileptic drugs during VEM is sparse, he noted.

In 158 patients who had been admitted for VEM to the university’s epilepsy monitoring unit during a 5-year period, antiepileptic drugs (AEDs), except for phenobarbital, were rapidly withdrawn in patients who had no history of status epilepticus. The patients also underwent supervised overnight sleep deprivation. Rapid withdrawal was performed by titrating AEDs to half-dose on admission and then discontinuing them at 24 hours. In cases in which there was a history of status epilepticus or in patients taking phenobarbital or high doses of benzodiazepines, AEDs were tapered by 25% of the initial dose and ultimately discontinued.

The patients had had a mean of almost 11 seizures in the month before VEM, and 70% of patients were on three or more AEDs. Their mean age was 37 years, and they had had epilepsy for a mean of 16 years (mean age of onset was 20.5 years).

About 5% of patients had complications, which were mostly minor, including musculoskeletal pain secondary to seizure activity. During the month after testing, four (2.5%) patients were admitted to the emergency department for seizure clustering, but none were admitted to the intensive care unit. There were no deaths.

About 90% of the patients were diagnosed on the basis of VEM results, "a high diagnostic yield," Dr. Rizvi said. Habitual seizures were detected in 107 patients and psychogenic nonepileptic seizures were diagnosed in 36 patients; in 15 patients (9.5%), no events were recorded during VEM.

Almost 33% – 52 of the 158 – patients had epilepsy surgery, based on the results. Of those patients who had surgery, almost 90% achieved an excellent outcome (Engel Class I or II status) at 24 months, he said, noting that these patients were "virtually seizure free" or had nondebilitating seizures.

Video-EEG monitoring was "highly effective. It’s a useful adjunct in decision making. It can help in deciding which patients are suitable for surgery" in the "appropriate context," with supervision by a team of epileptologists, nurses, and EEG technologists, Dr. Rizvi said during the press briefing. He said that he and his coinvestigators hope to expand the study to include elderly and pediatric patients.

The study was not funded. Dr. Rizvi, a senior neurology resident at the university, had no disclosures.

[email protected]