The effect of seizure-free period on seizure recurrence following antiseizure medication withdrawal: a systematic review and meta-analysis.
Hongye Zhou, Weihua Zhou, Xin Xu
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and random-effects meta-analysis examined whether the duration of seizure freedom before antiseizure medication (ASM) withdrawal is associated with subsequent seizure recurrence in people with epilepsy. The review identified 45 studies involving 10,896 patients; 22 studies with 3933 patients contributed to the meta-analysis. Across epilepsy populations, seizure freedom of <5 years was associated with greater recurrence risk than the comparator period (RR (95% CI) 1.49 (1.17-1.88), p=0.001). The authors also reported subgroup differences by age and region, while noting that evidence is insufficient for strong recommendations on withdrawal timing.
Key findings
- Across epilepsy populations, <5 years of seizure freedom was associated with greater recurrence risk (RR (95% CI) 1.49 (1.17-1.88), p=0.001).
- In paediatric patients, <3 years of seizure freedom was associated with higher relapse risk (RR(95% CI) 1.70(1.20-2.39),p=0.003).
- In adults, <5 years of seizure freedom was associated with higher relapse risk (RR (95% CI) 1.52 (1.02-2.26), p=0.04).
- The reported lower recurrence risk with ≥10 years of seizure freedom requires further validation because of limited participants and included studies.
Why it matters
The findings suggest that seizure-free duration is relevant when considering recurrence after ASM withdrawal, but the association varies across patient subgroups. This may help frame discussions about withdrawal timing and the uncertainty of relapse risk. The evidence does not establish a universally optimal seizure-free interval, and the authors caution that strong recommendations are not supported.
What to keep in mind
Only 22 of the 45 identified studies contributed to the meta-analysis. The authors specifically note limited participants and included studies for the ≥10-year finding, and state that stronger evidence is needed.