Antiepileptic drug withdrawal

Abstract

Epilepsy is a disorder characterized by recurrent epileptic seizures. Antiepileptic drugs are successful in preventing seizures for the majority of patients. When a person with epilepsy is seizure-free, drugs can be stopped in some cases without seizures returning. Because of serious side-effects, the benefits of drug withdrawal are clear. However, not taking medication causes unknown risks of seizure recurrence. The first focus of this thesis was to improve this risk assessment. In addition to drug treatment, some people can be treated with epilepsy surgery, with the goal of curing a patient by removing the source of the seizures. The second focus of the thesis was to study postoperative medication policy. For seizure-free patients on medication, and for children after epilepsy surgery, personalized prediction models are presented. These models allow for individual estimation of seizure recurrence risk after drug withdrawal. The models were converted to online tools which are available on www.epilepsypredictiontools.info. They are used in practice to counsel patients. Also in this thesis, the relation between drug treatment in children and their intelligence quotient was studied. Antiepileptic drugs may have a negative impact on cognitive development of children. Finally, we learned several aspects about postoperative medication policy. In the Netherlands, children who had surgery in later years stopped with medication earlier. In Europe, children more often stop drugs after surgery than adults. We found large variation between centers regarding policy, although most pedicatric epileptologists start postoperative drug withdrawal within the first year after surgery.