Safety and efficiency of medication withdrawal at home prior to long-term EEG video-monitoring
| Autor: | Wytske A. Hofstra, Renate van Griethuysen, Sandra M. A. van der Salm, Al W. de Weerd, Mireille D. Bourez-Swart |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male 040301 veterinary sciences Provocation test Video Recording Status epilepticus Statistics Nonparametric 0403 veterinary science Cohort Studies 03 medical and health sciences Epilepsy 0302 clinical medicine Psychogenic non-epileptic seizures medicine Humans Epilepsy surgery Adverse effect business.industry Electroencephalography 04 agricultural and veterinary sciences General Medicine Middle Aged medicine.disease Brain Waves Substance Withdrawal Syndrome Sleep deprivation Neurology Anesthesia Cohort Sleep Deprivation Anticonvulsants Female Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Seizure. 56 |
| ISSN: | 1532-2688 |
| Popis: | Purpose Long-term video-EEG monitoring (LTM) is frequently used for diagnostic purposes and in the workup of epilepsy surgery to determine the seizure onset zone. Different strategies are applied to provoke seizures during LTM, of which withdrawal of anti-epileptic drugs (AED) is most effective. Remarkably, there is no standardized manner of AED withdrawal. For instance, the majority of clinics taper medication during clinical admission, whereas we prefer to taper medication at home prior to admission. Our aim was to study the advantages (efficiency and diagnostic yield) and disadvantages (safety and complication rates) of predominantly tapering of medication at home. Method We report a retrospective observational cohort of 273 patients who had a LTM at our tertiary epilepsy center from 2005 until 2011. Provocation methods to induce seizures were determined on individual basis. Success rate (duration of admittance, time to first seizure, efficiency and diagnostic yield) and complications and serious adverse events were assessed. Results AED were tapered in 180 (66%) patients, in 93 (24%) of these patients with additional (partial) sleep deprivation. In all of these patients tapering started at home one to four weeks prior to admission. In the other patients, only (partial) sleep deprivation or none provocation method at all was applied. Seizure recordings were successful in 79,9% of patients. Complications occurred in 19 patients (10.9%) of which 3 had (1.7%) serious adverse events (status epilepticus (SE)) with AED withdrawal. These complications only occurred during admittance, not at home. Conclusions AED withdrawal at home prior to LTM is an efficient and convenient method to increase the diagnostic yield of LTM and appears relatively safe. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect