A Retrospective Analysis Of Risk Factors For Recurrence In Adult Epileptics After Drug Withdrawal

Objectives:The objectives of this study were to record the recurrence of adult epilepsy patients after drug withdrawal,to explore the relationship between seizure recurrence and several risk factors,to summarize the risk factors for recurrence of adult epilepsy patients after drug withdrawal,to assess the prognosis of epilepsy patients after drug withdrawal,to effectively avoid the risk factors,to minimize the risk of seizure recurrence,and to improve the quality of life of patients.Methods:In this study,103 patients with epilepsy who attended outpatient clinics and wards at Anhui Medical Provincial Hospital from January 2017 to December 2019,including 42 in the recurrence group and 61 in the non-recurrence group,were collected with detailed medical histories,including:name,gender,age,age of onset,seizure type,seizure frequency,type of medication used for AEDs,duration of seizure-free time before withdrawal,pre-drug withdrawal EEG,cranial imaging,family history,history of febrile convulsions and other information.Statistics were analyzed using SPSS 26.0 software,and risk factors for possible recurrence were analyzed using single-factor regression,and multi-factor logistic regression analysis was used if the single-factor analysis was statistically significant.Differences were considered statistically significant at P < 0.05.Results:Of the 103 patients with epilepsy in this study,42 were in the relapse group and 61 were in the non-relapse group,with a relapse rate of 40.78%(42/103)after withdrawal.The results of univariate analysis showed that there were no statistical differences in gender,age at onset,seizure type,family history,and history of febrile convulsions in the relapse group compared with the non-relapse group,and there were statistical differences in the duration of seizure-free time before withdrawal,seizure frequency,cranial imaging,EEG before withdrawal,and type of medication used for AEDs;logistic multi-factor regression analysis showed that the duration of seizure-free time <4 years before withdrawal,seizure frequency ≥5 times/ Logistic multivariate regression analysis showed that seizure-free time <4 years before withdrawal,seizure frequency ≥5 times/year,abnormal EEG before withdrawal,and combination of AEDs were independent risk factors for recurrence after withdrawal in adults with epilepsy.1.Gender: 70 male patients with a relapse rate of 40% and 33 female patients with a relapse rate of 42.42%,p=0.815,no statistically significant difference,i.e.no difference in relapse rate between male and female patients after withdrawal of medication.2.Age of onset: The recurrence rate was 29.41% in 34 patients with an age of onset <18 years and 46.38% in 69 patients with an age of onset ≥18 years,P=0.102,with no statistically significant difference,i.e.there was no difference in the recurrence rate after withdrawal between patients with an age of onset<18 years and those with an age of ≥18 years.3.Seizure type: The recurrence rate was 42.03% in 69 patients with generalized seizures and 35.29% in 34 patients with partial seizures,P=0.713,which was not statistically significant,i.e.there was no difference in the recurrence rate after withdrawal between patients with generalized and partial seizures.4.Seizure frequency: The relapse rate was 30.67% in 75 patients with seizure frequency <5 times/year and 67.86% in 28 patients with seizure frequency ≥5 times/year,P=0.001,a statistically significant difference,i.e.patients with seizure frequency ≥5 times/year were more likely to relapse after withdrawal.5.Seizure-free time before withdrawal: 54 patients with seizure-free time ≥4 years before withdrawal had a relapse rate of 29.63%,while 49 patients with seizure-free time <4 years before withdrawal had a relapse rate of 53.06%,P=0.017,a statistically significant difference,i.e.patients with seizure-free time <4 years before withdrawal were more likely to relapse after withdrawal.6.EEG before withdrawal: 71 patients with normal EEG before withdrawal had a relapse rate of 28.17%,while 32 patients with abnormal EEG before withdrawal had a relapse rate of 68.75%,P=0.000,a statistically significant difference,i.e.patients with abnormal EEG before withdrawal were more likely to relapse after withdrawal.7.Cranial imaging performance: 93 patients with no lesions on cranial imaging,recurrence rate of 31.18%,20 patients with lesions on cranial imaging,recurrence rate of 65%,P=0.018,the difference is statistically significant,i.e. patients with lesions on cranial imaging are more likely to relapse after withdrawal.8.Type of medication used for AEDs: The recurrence rate was 28.36% in 67 patients treated with single medication and 63.89% in 36 patients treated with combined medication,P=0.001,a statistically significant difference,i.e.patients treated with combined medication were more likely to have a recurrence after withdrawal.9.Family history of epilepsy: 89 patients with no family history of epilepsy had a recurrence rate of 40.45% and 14 patients with a family history of epilepsy had a recurrence rate of 42.86%,P=0.865,which is not statistically significant,i.e.there was no difference in the recurrence rate after withdrawal of medication between patients with and without family history of epilepsy.10.History of febrile convulsions: 80 patients with no history of febrile convulsions had a recurrence rate of 41.25% and 23 patients with a history of febrile convulsions had a recurrence rate of 39.13%,P=0.855,the difference was not statistically significant,i.e.there was no difference in the recurrence rate after withdrawal of medication between patients with and without a history of febrile convulsions.11.The results obtained after Logistc multi-factor regression analysis of the factors that were statistically different in the above results showed that the difference in the presence of lesions on cranial imaging(P=0.646,OR=0.646) was not statistically significant and was not a risk factor for relapse after withdrawal;seizure frequency ≥5 times/year(P=0.044,OR=3.128),seizure-free time before withdrawal <4(P=0.002,OR=5.936),abnormal EEG before withdrawal(P=0.019,OR=3.653),and combination of AEDs(P=0.006,OR=4.900)were all statistically significant,demonstrating that the above factors were risk factors for recurrence after withdrawal in adults with epilepsy.Conclusions:Recurrence after withdrawal in adult epilepsy patients was associated with the duration of seizure-free time before withdrawal,seizure frequency,cranial imaging,EEG before withdrawal,and type of AEDs medication.Among them,seizure frequency ≥5 times/year,seizure-free time<4 years before withdrawal,abnormal EEG before withdrawal,and AEDs combination medication were risk factors for recurrence after withdrawal in adult epilepsy patients.Clinical withdrawal of medication for patients with epilepsy should be considered on an individual basis and assessed comprehensively to reduce the recurrence rate of epilepsy and improve the quality of life of patients.