Maria Oto1, Colin A Espie, Roderick Duncan. 1. West of Scotland Regional Epilepsy Service, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, United Kingdom. meritxelloto@hotmail.com
Abstract
PURPOSE: To determine whether withdrawal of antiepileptic drugs (AEDs) in patients with psychogenic nonepileptic attacks (PNEAs) improves outcome. METHODS: Randomized controlled trial of AED withdrawal in patients with PNEAs. Patients were randomized to immediate or delayed (9 months) withdrawal of AEDs. We recorded spell frequency, changes in work status, use of emergency medical services, and psychological status at baseline, 9 months, and 18 months. RESULTS: Of 193 patients screened, 38 fulfilled entry criteria, 13 declined participation, and 25 were randomized. Fourteen patients were randomized to immediate withdrawal (IW) and 11 patients to delayed withdrawal (DW). There was a significant reduction in spell frequency from baseline to 9 months in the IW group but not in the DW group (p = 0.028). There was a significantly greater reduction in use of rescue medication in the IW group compared to the DW group between baseline and 9 months (p = 0.002). Emergency health care utilization dropped to zero in both groups by the end of the study. Psychological measures reflecting internal locus of control increased significantly more in the IW group (p = 0.005). DISCUSSION: Stringent diagnostic criteria and an increasing tendency for patients to be referred before AED prescription limited the recruitment and the power of the study. Our data nonetheless provide evidence that some outcomes are improved by AED withdrawal in patients with PNEAs. Wiley Periodicals, Inc.
RCT Entities:
PURPOSE: To determine whether withdrawal of antiepileptic drugs (AEDs) in patients with psychogenic nonepileptic attacks (PNEAs) improves outcome. METHODS: Randomized controlled trial of AED withdrawal in patients with PNEAs. Patients were randomized to immediate or delayed (9 months) withdrawal of AEDs. We recorded spell frequency, changes in work status, use of emergency medical services, and psychological status at baseline, 9 months, and 18 months. RESULTS: Of 193 patients screened, 38 fulfilled entry criteria, 13 declined participation, and 25 were randomized. Fourteen patients were randomized to immediate withdrawal (IW) and 11 patients to delayed withdrawal (DW). There was a significant reduction in spell frequency from baseline to 9 months in the IW group but not in the DW group (p = 0.028). There was a significantly greater reduction in use of rescue medication in the IW group compared to the DW group between baseline and 9 months (p = 0.002). Emergency health care utilization dropped to zero in both groups by the end of the study. Psychological measures reflecting internal locus of control increased significantly more in the IW group (p = 0.005). DISCUSSION: Stringent diagnostic criteria and an increasing tendency for patients to be referred before AED prescription limited the recruitment and the power of the study. Our data nonetheless provide evidence that some outcomes are improved by AED withdrawal in patients with PNEAs. Wiley Periodicals, Inc.
Authors: Susannah Pick; David G Anderson; Ali A Asadi-Pooya; Selma Aybek; Gaston Baslet; Bastiaan R Bloem; Abigail Bradley-Westguard; Richard J Brown; Alan J Carson; Trudie Chalder; Maria Damianova; Anthony S David; Mark J Edwards; Steven A Epstein; Alberto J Espay; Béatrice Garcin; Laura H Goldstein; Mark Hallett; Joseph Jankovic; Eileen M Joyce; Richard A Kanaan; Roxanne C Keynejad; Kasia Kozlowska; Kathrin LaFaver; W Curt LaFrance; Anthony E Lang; Alex Lehn; Sarah Lidstone; Carine W Maurer; Bridget Mildon; Francesca Morgante; Lorna Myers; Clare Nicholson; Glenn Nielsen; David L Perez; Stoyan Popkirov; Markus Reuber; Karen S Rommelfanger; Petra Schwingenshuh; Tereza Serranova; Paul Shotbolt; Glenn T Stebbins; Jon Stone; Marina Aj Tijssen; Michele Tinazzi; Timothy R Nicholson Journal: J Neurol Neurosurg Psychiatry Date: 2020-02-28 Impact factor: 10.154