Seizure recurrence proportion under antiseizure medication in people living with epilepsy and prolonged seizure remission: A systematic review

Abstract

Background and purpose: People living with epilepsy (PLWE) may wish to discontinue antiseizure medications (ASMs) after long-term remission. However, fear of relapse may lead to continued ASM use. Previous studies have focused on seizure relapse in PLWE who discontinued ASMs after long-term seizure remission (PLWE off ASM), with limited data on those who continued ASMs (PLWE on ASM). Methods: We conducted a systematic review and meta-analysis of studies from five databases. We included studies with adult PLWE on ASM with long-term follow-up, using a common-effect model for analysis. Results: Seven datasets from six studies were reviewed. Three of the six studies appeared to include some children and adolescents. Significant differences in seizure recurrence proportions (SRP) were found between PLWE whose seizures were controlled on one ASM (PLWE on one ASM) and those whose seizures were controlled on multiple ASMs (PLWE on multiple ASMs) over one to five years of follow-up. After two years, the SRP was 0.1416 for PLWE on one ASM and 0.2479 for PLWE on multiple ASMs. The relative risk (RR) of seizure recurrence for PLWE off ASM compared to PLWE on ASM was 1.9912 after two years, with the RR decreasing over time. Discussion: Among PLWE on ASM, PLWE on one ASM have a lower chance of seizure recurrence than PLWE on multiple ASMs. PLWE off ASM have twice the risk of recurrence compared to PLWE on ASM after two years. This information aids PLWE in making informed decisions about ASM continuation or discontinuation. © 2024