BACKGROUND Approximately two-thirds of patients with newly diagnosed epilepsy become seizure-free after antiepileptic drug (AED) treatment. A crucial issue for these patients and their families, especially after a long period of seizure freedom, is when to stop their medications. OBJECTIVE The aim of this study was to identify the optimal timing of AED withdrawal in adults with focal epilepsy who had been seizure-free for ≥ 2 years. METHODS Adults with focal epilepsy who had been seizure-free for ≥ 2 years were recruited. Based on their decision to discontinue (withdrawal) or continue (non-withdrawal) AED treatment, patients were assigned to withdrawal or non-withdrawal subgroups according to the length of remission (2 to < 3 years, 3 to < 4 years, 4 to < 5 years and ≥ 5 years). The relapse risks of the withdrawal and corresponding non-withdrawal subgroups were compared, and the relative relapse risks were assessed in a Cox proportional hazard regression model. RESULTS A total of 213 eligible patients began to withdraw from AED treatment; 70 had been seizure-free for 2 to < 3 years, 62 had been seizure-free for 3 to < 4 years, 37 had been seizure-free for 4 to < 5 years and 44 had been seizure-free for ≥ 5 years. The figures for the corresponding non-withdrawal subgroups were 463, 334, 251 and 182, respectively. There was a significantly higher risk of seizure relapse in patients withdrawing from AEDs after 2 to < 5 years of seizure freedom than in the corresponding non-withdrawal controls, and the relative relapse risk was 3.052 (95% confidence interval [CI] 2.126-4.381; p < 0.001) for the seizure-free period of 2 to < 3 years, 3.617 (95% CI 2.384-5.488; p < 0.001) for 3 to < 4 years and 2.644 (95% CI 1.456-4.799; p = 0.001) for 4 to < 5 years. However, for patients who were seizure-free for ≥ 5 years, AED withdrawal did not significantly increase the risk of seizure relapse compared with that of patients continuing treatment (hazard ratio [HR] 1.362, 95% CI 0.634-2.926, p = 0.428). Compared with a seizure-free period of 2 to < 3 years, the relative relapse risk after AED withdrawal was significantly reduced only after being seizure-free for ≥ 5 years (HR 0.441, 95% CI 0.233-0.834; p = 0.012). CONCLUSION Overall, for adults with focal epilepsy, withdrawal from AEDs significantly increased the risk of seizure relapse after being seizure-free for 2 to < 5 years, but might not increase the risk if the seizure-free period was ≥ 5 years.

中文翻译：

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成人局灶性癫痫在不同的无癫痫发作期后与抗癫痫药撤药相关的相对癫痫复发风险：一项前瞻性，对照随访研究。

背景技术在抗癫痫药（AED）治疗后，大约三分之二的新诊断为癫痫病的患者无癫痫发作。对于这些患者及其家人来说，一个关键问题是何时停止服药，尤其是在长时间的癫痫发作后。目的本研究的目的是确定无癫痫发作≥2年的局灶性癫痫成年人AED退出的最佳时机。方法招募无癫痫发作≥2年的局灶性癫痫成人。根据他们决定中止（退出）或继续（不退出）AED治疗的决定，根据缓解时间（2至<3年，3至<4年，4至4至4年）将患者分为退出或不退出亚组。 <5年且≥5年）。比较戒断者和相应的非戒断亚组的复发风险，并在Cox比例风险回归模型中评估相对复发风险。结果共有213名合格的患者开始退出AED治疗。70例2到<3年内无癫痫发作，62例3到<4年内无癫痫发作，37例4到<5年内无癫痫发作，44例≥5年无癫痫发作。相应的非提款子组的数字分别为463、334、251和182。癫痫发作自由2至<5年后，退出AED的患者发生癫痫复发的风险显着高于相应的非退出对照组，相对复发风险为3.052（95％置信区间[CI] 2.126-4.381） ; p <0。001）为2至<3年的无癫痫发作期，3至4年为3.617（95％CI 2.384-5.488; p <0.001），4为2.644（95％CI 1.456-4.799; p = 0.001） <5年。但是，对于无癫痫发作≥5年的患者，与继续治疗的患者相比，AED停药并没有显着增加癫痫复发的风险（危险比[HR] 1.362，95％CI 0.634-2.926，p = 0.428 ）。与2至<3年的无癫痫发作期相比，AED撤药后的相对复发风险只有在无癫痫发作≥5年后才显着降低（HR 0.441，95％CI 0.233-0.834； p = 0.012）。结论总体而言，对于患有局灶性癫痫的成年人，退出AED会显着增加无癫痫发作2至5年后癫痫复发的风险，