Seizure-recurrence risk in persons with epilepsy undergoing antiepileptic drug tapering.

Antiepileptic drug (AED) tapering in persons with epilepsy (PWE) after 2-3 years of seizure freedom is still debatable because of the risk of seizure recurrence. Tapering patterns have wide variability and could impact seizure-recurrence; this study aimed to find out the correlation between them.This prospective, observational independent assessor study enrolled PWE undergoing AED tapering in a tertiary care hospital. Data collected included demography, seizure history, AED treatment and investigational findings. Tapering pattern was assessed based on seizure-free period and AED dose before onset of tapering, dose reduction percentage and frequency, duration of tapering and follow-up. These variables were compared among the PWE with seizure-recurrence and no seizure-recurrence.Among 408 enrolled PWE, 181 were on AED monotherapy: levetiracetam (73), valproate (45), carbamazepine (44), phenytoin (16) and clobazam (3). With a minimum 19 (maximum 41 months) follow up, seizure-recurrence was reported in 119 (29.2%) PWE. The seizure-recurrence was not significantly different in-between mono and polytherapy groups; however, among monotherapy groups seizure-recurrence was significantly higher (p=0.023) in valproate (35.5%) followed by levetiracetam (28.8%) group. Parameters having significant association with seizure-recurrence were duration of epilepsy (p=0.03), frequency of seizures before control (p=0.002), history of previously failed tapering (p=0.04) and history of smoking/alcoholic/tobacco intake (p=0.003).There is a wide variation in AEDs tapering pattern and seizure-recurrence risk can be minimized by considering the risk factors like history of smoking/alcoholic/tobacco, longer duration of epilepsy, frequency of seizures before control and previously failed tapering.