Is rapid withdrawal of anti-epileptic drug therapy during video EEG monitoring safe and efficacious?
Is rapid withdrawal of anti-epileptic drug therapy during video EEG monitoring safe and efficacious?
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DOI：
10.1016/j.eplepsyres.2014.01.022
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发表时间：
2014-05-01
影响因子：
2.2
通讯作者：
Zenteno, Jose F. Tellez
中科院分区：
文献类型：
--
作者：
Rizvi, Syed A. A.;Hernandez-Ronquillo, Lizbeth;Zenteno, Jose F. Tellez
目的：视频脑电图监测（VEM）用于记录发作期和发作间期的癫痫样活动，并确定两者之间的一致性水平。通常，需要逐渐减少或停止抗癫痫（AED）治疗以促进癫痫发作。这种做法的安全性尚不清楚，长期的后遗症还有待阐明。方法：这是一项前瞻性研究的158例患者合并睡眠剥夺VEM与快速AED撤药，评估癫痫样发作超过24个月的照顾下，直接护理观察和EEG技术人员的支持，在我们的遥测单位。在大多数情况下，AED在入院后24小时内停用。我们评估了VEM的诊断率和安全性以及癫痫手术outcomes.Results：VEM回答了90.5%的病例的研究问题，但未能记录9.5%的发作事件。这一诊断率是在平均VEM持续时间为4.53 +/- 1.44天的情况下实现的，更长时间的监测没有任何益处。这些发现通过优化医疗和手术治疗计划改善了生活质量，从而改善了癫痫控制。总体而言，32.9%的队列接受了癫痫手术。并发症发生率为5.06%，主要表现为继发于临床癫痫发作活动的肌肉骨骼疼痛，未观察到死亡。在第一个月后，VEM 2.5%的患者接受急诊室入院癫痫clustering.Conclusions：VEM结合睡眠剥夺和协议快速AED撤药是一种安全有效的调查技术，没有不良的长期后遗症。这是一个可靠的策略，治疗计划，并可用于确定候选人的外科治疗。(C)2014爱思唯尔有限公司版权所有。
Purpose: Video electroencephalographic monitoring (VEM) is used to record ictal and interictal epileptiform activity and to ascertain the level of concordance between the two. Often, taper or discontinuation of anti-epileptic (AED) therapy is needed to facilitate seizure occurrence. The safety of this practice is unclear and long-term sequelae have yet to be elucidated.Methods: This is a prospective study of 158 patients subjected to combined sleep-deprived VEM with rapid AED withdrawal, for evaluation of seizure-like episodes over 24 months under the care of an epileptologist with direct nursing observation and EEG technician support in our telemetry unit. In most cases, AEDs were discontinued within 24 h of admission. We assessed the diagnostic yield and safety of VEM as well as epilepsy surgery outcomes.Results: VEM answered the study question in 90.5% of cases but failed to record ictal events in 9.5%. This diagnostic yield was achieved over a mean VEM duration of 4.53 +/- 1.44 days, with no benefit of longer monitoring. These findings improved quality of life by optimizing medical and surgical therapeutic planning, leading to improved seizure control. Overall, 32.9% of the cohort received epilepsy surgery. The complication rate was 5.06%, characterized largely by musculoskeletal pain secondary to clinical seizure activity, with no mortality observed. In the first month following VEM 2.5% of patients received emergency-room admission for seizure clustering.Conclusions: VEM with combined sleep deprivation and protocolized rapid AED withdrawal is a safe and effective investigative technique with no adverse long-term sequelae. It is a reliable strategy for therapeutic planning and can be used to determine candidacy for surgical treatment. (C) 2014 Elsevier B.V. All rights reserved.