AAN guideline on withdrawing anticonvulsants in seizure-free adults and children

Référence

Gloss D, Pargeon K, Pack A, et al, for the AAN Guideline Subcommittee. Antiseizure medication withdrawal in seizure-free patients: Practice advisory update summary: Report of the AAN Guideline Subcommittee. Neurology 2021;97(23):1072-1081.

Sommaire

To update its 1996 recommendations on anticonvulsant withdrawal, the American Academy of Neurology (AAN) convened a panel of general AAN members, clinicians with expertise in epilepsy, and a methodologist — no patients or primary care clinicians. The AAN tried to minimize conflicts of interest among the panelists. The panel used systematic reviews to inform their recommendations. The panel addressed various outcomes mostly after 12 months or more of withdrawal: seizure recurrence, quality of life, mortality, and status epilepticus. One of the problems with the data was the variability in seizure-free intervals used in the reviews: 12 to 60 months. Ultimately, the panel recommended that adults who have been seizure-free for at least 24 months should engage in shared decision-making with their clinicians to determine the benefits and harms of continuing anticonvulsants. The panel could draw no conclusions as to the utility of electroencephalograms or other imaging in guiding these decisions among adults. The panel also could make no recommendations about medication withdrawal after epilepsy surgery. Among children who have abnormal electroencephalograms, the panel does not recommend medication withdrawal. Otherwise, in children who have been seizure-free for 18 to 24 months, the panel recommends shared decision-making to determine the benefits and harms of continuing anticonvulsants. Finally, the panel identified several areas in need of research.