Transient improvement after brief antiepileptic drug withdrawal in the epilepsy monitoring unit—possible relationship to AED tolerance

Summary Purpose:  A drug holiday seems to produce seizure interval prolongation (SIP) after reinstitution of antiepileptic drugs (AEDs). This effect was demonstrated mainly with carbamazepine. We evaluated SIP with newer AEDs and tested the relationship of SIP to history of AED tolerance. Methods: ...

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Bibliographic Details
Published in:Epilepsia (Copenhagen) 2010-05, Vol.51 (5), p.811-817
Main Authors: Azar, Nabil J., Lagrange, Andre H., Wang, Lily, Song, Yanna, Abou‐Khalil, Bassel W.
Format: Article
Language:English
Subjects:
Adult
Anticonvulsants - therapeutic use
Anticonvulsants. Antiepileptics. Antiparkinson agents
Antiepileptic drug withdrawal
Biological and medical sciences
Carbamazepine - analogs & derivatives
Carbamazepine - therapeutic use
Drug Administration Schedule
Drug holiday
Drug Resistance
Drug Tolerance
Electroencephalography - statistics & numerical data
Epilepsy - diagnosis
Epilepsy - drug therapy
Epilepsy monitoring
Female
Follow-Up Studies
Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy
Humans
Male
Medical sciences
Nervous system (semeiology, syndromes)
Neurology
Neuropharmacology
Pharmacology. Drug treatments
Piracetam - analogs & derivatives
Piracetam - therapeutic use
Seizure interval
Severity of Illness Index
Substance Withdrawal Syndrome - diagnosis
Substance Withdrawal Syndrome - etiology
Treatment Outcome
Triazines - therapeutic use
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Summary:Summary Purpose:  A drug holiday seems to produce seizure interval prolongation (SIP) after reinstitution of antiepileptic drugs (AEDs). This effect was demonstrated mainly with carbamazepine. We evaluated SIP with newer AEDs and tested the relationship of SIP to history of AED tolerance. Methods:  We prospectively studied patients with refractory epilepsy admitted to the Vanderbilt epilepsy monitoring unit (EMU) over a period of 12 months. We included only patients on levetiracetam, lamotrigine, or oxcarbazepine who had their AEDs withdrawn on admission and reinstituted without change upon discharge. We defined SIP as the interval from EMU discharge to first seizure minus the interval between the last two seizures before EMU admission. Results:  A total of 43 patients completed the study; 15 were on monotherapy. SIP was greater than zero in this patient group (p 
ISSN:0013-9580
1528-1167
DOI:10.1111/j.1528-1167.2009.02494.x