Purpose To analyze the effect of medication withdraw (MW) on long-term electroencephalogram (EEG) monitoring in children who need preoperative assessment for refractory epilepsy.Methods Retrospective analysis was performed on the data of preoperative long-term EEG monitoring of children with refractory epilepsy who needed preoperative evaluation in the Pediatric Epilepsy Center of Peking University First Hospital from August 2018 to December 2019. Monitoring duration: at least three habitual seizures were detected, or the monitoring duration were as long as 10 days. MW protocol was according to the established plan.Results A total of 576 children (median age 4.4 years) required presurgical ictal EEGs, and 75 (75/576, 13.0%) needed MW for ictal EEGs. Among the 75 cases, 38 were male and 37 were female. The age range was from 15 months to 17 years (median age: 7.0 years). EEG and clinical data of with 65 children who strictly obey the MW protocol were analyzed. The total monitoring duration range was from 44.1 h (about 2 days) to 241.8 h (about 10 days)(median: 118.9 h (about 5 days)). Interictal EEG features before MW were including focal interictal epileptiform discharge (IED) in 39 cases (39/65, 60%), focal and generalized IED in 2 cases (2/65, 3.1%), multifocal IED in 20 cases (20/65, 30.7%), multifocal and generalized IED in 2 cases (2/65, 3.1%), and no IED in 2 cases (2/65, 3.1%). After MW, 18 cases (18/65, 27.7%) had no change in IED and the other 47 cases had changes of IED after MW. And IEDs in 46 cases (46/65, 70.8%) were aggravated, and IED was decreased in 1 case. The pattern of aggravated IED was original IED increasement, in 41 cases (41/46, 89.1%), and 5 cases (5 /46, 10.9%) had generalized IED which was not detected before MW. Of the 46 patients with IED exacerbations, 87.3% appeared within 3 days after MW. Habitual seizures were detected in 56 cases (86.2%, 56/65) after MW, and within 3 days of MW in 80.4% cases. Eight patients (14.3%) had secondary bilateral-tonic seizure (BTCS), of which only 1 patient had no BTCS in his habitual seizures. In 56 cases, 94.6% (53/56) had seizures after MW of two kinds of AEDs.Conclusions ① In this group, thirteen percent children with intractable epilepsy needed MW to obtain ictal EEG; ② Most of them (86.2%) could obtain ictal EEG by MW. The IED and ictal EEG after MW were still helpful for localization of epileptogenic zone; ③ Most of the patients can obtain ictal EEG within 3 days after MW or after MW of two kinds of AEDs;4. The new secondary generalization was extremely rare.
Citation:
WANG Wen, WANG Shuang, YU Guojing, LIU Tong, LIU Xiaoyan, CAI Lixin. The effect of medication withdraw on long-term electroencephalogram monitoring in children who need preoperative assessment for refractory epilepsy. Journal of Epilepsy, 2021, 7(2): 93-97. doi: 10.7507/2096-0247.20210016
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1. |
Luders HO, Najm I, Nair D, et al. The epileptogenic zone: generalprinciples. EpilepticDisord, 2006, 8(Suppl 2): S1-9.
|
2. |
Morris H, Najm I, Kahane P. Epilepsy surgery: patient selection[A]//Luders HO. Textbook of epilepsy surgery[M]. London: InformaHealthcare, 2008: 230-237.
|
3. |
Rizvi SA, Hernandez-Ronquillo L, Wu A, et al. Is rapid withdrawalof anti-epileptic drug therapy during video EEG monitoring safeand efficacious. Epilepsy Res, 2014, 108(4): 755-764.
|
4. |
Quan Z, Xiaobing H, Zhimin H. Slow anti-epileptic drug taper protocol in video-EEG monitoring for presurgical evaluation of epilepsy. Journal of Southern Medical University, 2012, 32(8): 1197.
|
5. |
Andersen NB, Alving J, Beniczky S. Effect o fmedication withdrawal on the interictal epileptiform EEG discharges in presurgical evaluation. Seizure, 2010, 19(3): 137-139.
|
6. |
Sun P, Wyatt K, Nickels K, et al. Predictors of length of stay in children admitted for a pre-surgical evaluation. Pediatric Neurology, 2015, 53: 207-210.
|
7. |
Kagawa K, Iida K, Baba S, et al. Effectivewithdrawal of antiepileptic drugs in premonitoring admission to capture seizuresduring limited video-EEG monitoring. Epilepsia Open, 2017, 2(2): 172-179.
|
8. |
Al Kasab S, Dawson RA, Jaramillo JL, et al. Correlation of seizure frequencyand medication down-titration rate during video-EEG monitoring. Epilepsy Behav, 2016, 64(Pt A): 51-56.
|
9. |
胡小伟, 高薇, 方琪. 长程视频脑电图联合减停抗癫痫药物在癫痫术前评估中的应用进展. 中华神经医学杂志, 2017, 16(2): 209-213.
|
10. |
Rosenow F, Lüders H. Presurgical evaluation of epilepsy. Brain, 2001, 124: 1683-1700.
|
11. |
Swick CT, Bouthillier A, Spencer SS. Seizure occurrence duringlong-term monitoring. Epilepsia, 1996, 37(10): 927-930.
|
12. |
Hui AC, Kwan P, Leung TW, et al. Diagnostic value and safety oflong-term video-EEG monitoring. Hong Kong Med J, 2007, 13(3): 228-230.
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- 1. Luders HO, Najm I, Nair D, et al. The epileptogenic zone: generalprinciples. EpilepticDisord, 2006, 8(Suppl 2): S1-9.
- 2. Morris H, Najm I, Kahane P. Epilepsy surgery: patient selection[A]//Luders HO. Textbook of epilepsy surgery[M]. London: InformaHealthcare, 2008: 230-237.
- 3. Rizvi SA, Hernandez-Ronquillo L, Wu A, et al. Is rapid withdrawalof anti-epileptic drug therapy during video EEG monitoring safeand efficacious. Epilepsy Res, 2014, 108(4): 755-764.
- 4. Quan Z, Xiaobing H, Zhimin H. Slow anti-epileptic drug taper protocol in video-EEG monitoring for presurgical evaluation of epilepsy. Journal of Southern Medical University, 2012, 32(8): 1197.
- 5. Andersen NB, Alving J, Beniczky S. Effect o fmedication withdrawal on the interictal epileptiform EEG discharges in presurgical evaluation. Seizure, 2010, 19(3): 137-139.
- 6. Sun P, Wyatt K, Nickels K, et al. Predictors of length of stay in children admitted for a pre-surgical evaluation. Pediatric Neurology, 2015, 53: 207-210.
- 7. Kagawa K, Iida K, Baba S, et al. Effectivewithdrawal of antiepileptic drugs in premonitoring admission to capture seizuresduring limited video-EEG monitoring. Epilepsia Open, 2017, 2(2): 172-179.
- 8. Al Kasab S, Dawson RA, Jaramillo JL, et al. Correlation of seizure frequencyand medication down-titration rate during video-EEG monitoring. Epilepsy Behav, 2016, 64(Pt A): 51-56.
- 9. 胡小伟, 高薇, 方琪. 长程视频脑电图联合减停抗癫痫药物在癫痫术前评估中的应用进展. 中华神经医学杂志, 2017, 16(2): 209-213.
- 10. Rosenow F, Lüders H. Presurgical evaluation of epilepsy. Brain, 2001, 124: 1683-1700.
- 11. Swick CT, Bouthillier A, Spencer SS. Seizure occurrence duringlong-term monitoring. Epilepsia, 1996, 37(10): 927-930.
- 12. Hui AC, Kwan P, Leung TW, et al. Diagnostic value and safety oflong-term video-EEG monitoring. Hong Kong Med J, 2007, 13(3): 228-230.