WASHINGTON, DC—Discontinuation of antiepileptic drug (AED) therapy during concurrent video and EEG monitoring (vEEG) may be safe for patients with epilepsy, according to research presented at the 67th Annual Meeting of the American Epilepsy Society.
To determine the safety and long-term effects of AED withdrawal or discontinuation during this diagnostic procedure, investigators at the University of Saskatchewan in Saskatoon, Canada, conducted a prospective study of 150 patients with epilepsy admitted to their vEEG telemetry unit over a period of five years. Neurologists discontinued the patients’ medication therapy according to a standardized rapid AED withdrawal protocol. Rapid discontinuation was not performed for patients with a history of status epilepticus or phenobarbital exposure. The researchers then assessed the number of patients who had subsequent seizures, the safety of the withdrawal and telemetry procedures, and epilepsy surgery outcomes.
The group recorded seizures and nonepileptic events in 84.8% of the patients. This diagnostic yield was achieved over a mean monitoring duration of 4.53 days. The researchers found no benefit of longer monitoring. Habitual seizures were recorded in 107 patients to support a diagnosis of epilepsy. The investigators recorded nonepileptic events in 36 patients. The vEEG findings changed patient management for 93% of the cohort and likely improved quality of life by decreasing AED consumption and reducing seizure frequency.
Overall, 34% of the patients received epilepsy surgery. The probability of a good outcome (ie, Engel Class I or II) at 24 months was 78% among patients who underwent surgery and 40% among patients who did not. The overall complication rate of the surgery was 5.3%, and the most common complication was musculoskeletal pain secondary to clinical seizure activity. The investigators observed no mortality following surgery. In the first month following monitoring, 2.5% of patients were admitted to an emergency room for seizure clustering.
“VEEG telemetry monitoring with early cessation of AED therapy is safe and effective,” said Syed A. Rizvi, MD, neurology resident at the University of Saskatchewan and lead author of the report. “Surgical outcomes are favorable and support the use of this technique under the supervision of a team comprising epileptologists, nurses, and EEG technologists.”
—Erik Greb