Effect of reduction of antiepileptic drugs in patients with drug-refractory epilepsy

• We enrolled 962 patients with drug refractory epilepsy.
• We reduced the number of AEDs to a maximum of three AEDs during their stay in neurology ward.
• We followed-up these patients for a period of 6 months after reduction of drugs.
• After the tapering each patient received a mean of 2.65 AEDs per patient.
• In 82.7% patients there was either a reduction or no change in seizure frequency over the next 6 months.

PurposeThe present study was conducted with the aim of evaluating the effects of reducing the number of antiepileptic drugs (AEDs) administered to patients with drug-refractory epilepsy (DRE) during their admission and document any change in seizure frequency in subsequent follow up.MethodsA total of 962 patients with DRE who were admitted to the neurology wards waiting for connection to video EEG were recruited for this prospective study. After their admission to the neurology ward, modifications in the number and dosage of AEDs were done with a target of a maximum of three AEDs in every patient. Drug tapering was done using a standardized protocol. The primary outcome was the change in seizure frequency in the follow-up period of 6 months. Secondary outcome measures were the adverse event profile (AEP) and the quality of life (QOL).ResultsOf the 1134 patients screened, 962 patients gave consent to participate in the study. The mean number of AEDs received by each patient was 4.24. After the tapering following a standardized protocol each patient received a mean of 2.65 AEDs per patient. In 82.70% patients with DRE, there was either a reduction or no change in seizure frequency in the subsequent 6 months follow up. There was a significant reduction in the AEP score after the reduction in the number of AEDs (P = 0. 001).ConclusionOur study proves that optimization of reduction of the number of AED's in patients with DRE leads to reduction or no change in seizure frequency with a significant decrease in adverse effects.