The effect of seizure-free period on seizure recurrence following antiseizure medication withdrawal: a systematic review and meta-analysis.
完整摘要 · 中文译文
背景：撤药前的无发作期是影响癫痫复发风险的重要因素。本研究旨在评估无发作期对癫痫人群抗癫痫药物（ASM）撤药后复发风险的影响，并确定ASM撤药的最佳时机。 方法：检索Cochrane对照试验中心注册库、PubMed和Web of Science，检索时间为建库至2025年11月2日发表的文献。主要结局为癫痫患者ASM撤药后的复发风险。根据异质性采用随机效应荟萃分析模型估计合并复发风险。 结果：共纳入45项研究、10,896例患者；其中22项研究、3933例患者纳入荟萃分析。根据对所有癫痫患者的分析，无发作期<5年的患者复发风险更高（RR（95% CI）1.49（1.17-1.88），p=0.001）。我们的结果还显示，无发作期≥10年的患者复发风险更高（RR（95% CI）0.21（0.09-0.49），p<0.001）；然而，由于参与者数量和研究纳入有限，仍需进一步验证。在亚组分析方面，无发作期<3年的儿童患者、无发作期<5年的成人患者、无发作期<2年的欧洲患者和无发作期<3年的中东患者复发风险更高（RR（95% CI）1.70（1.20-2.39），p=0.003；RR（95% CI）1.52（1.02-2.26），p= 0.04；RR（95% CI）2.11（1.48-2.99），p<0.001；RR（95% CI）1.87（1.41-2.48），p<0.001；RR（95% CI）1.37（1.03-1.83），p=0.03）。 意义：无发作期可能是影响患者停用抗癫痫发作药物（ASM）后复发风险的重要因素。在缺乏关于无发作期与癫痫发作复发风险的强烈推荐意见和证据的情况下，本荟萃分析为癫痫亚群中ASM停用的最佳时机提供了证据。
完整摘要 · 英文原文
BACKGROUND: The seizure-free period before withdrawal is an important factor that influences the risk of epilepsy relapse. Our study aimed to evaluate the effect of the seizure-free period on the relapse risk after antiseizure medication(ASM) withdrawal in epilepsy populations and identify the optimal timing of ASM withdrawal. METHODS: The Cochrane Central Register of Controlled Trials, PubMed and Web of Science were searched for literature published from inception to November 2, 2025. The primary outcome was the relapse risk of epilepsy patients after ASM withdrawal. Random-effects meta-analysis models were used to estimate the pooled recurrence risk based on heterogeneity. RESULTS: We identified 45 studies with 10,896 patients; 22 studies with 3933 patients were included in the meta-analysis. According to the analyses of all the epilepsy patients, there was a greater risk of recurrence in patients with <5 years of seizure freedom (RR (95% CI) 1.49 (1.17-1.88), p=0.001). Our results also revealed that patients with ≥10 years of seizure freedom had a higher risk of recurrence (RR (95% CI) 0.21 (0.09-0.49), p<0.001); however, it needs further validation due to the limited number of participants and the inclusion of studies. With respect to the subgroup analyses, paediatric patients who had <3 years of seizure freedom, adult patients who had <5 years of seizure freedom, European patients who had <2 years of seizure freedom and Middle Eastern patients who had <3 years of seizure freedom had a higher relapse risk(RR(95% CI) 1.70(1.20-2.39),p=0.003; RR(95% CI) 1.52(1.02-2.26),p=0.04; RR(95% CI) 2.11(1.48-2.99),p<0.001; RR(95% CI) 1.87 (1.41-2.48),p<0.001; RR(95% CI) 1.37(1.03-1.83),p=0.03). SIGNIFICANCE: The seizure-free period may be an important factor that influences patients' risk of recurrence after ASM withdrawal. Without strong recommendations and evidence regarding the seizure-free period and risk of seizure recurrence, this meta-analysis provides evidence of the optimal timing of ASM withdrawal in epilepsy subpopulations.
摘要 待译
BACKGROUND: The seizure-free period before withdrawal is an important factor that influences the risk of epilepsy relapse. Our study aimed to evaluate the effect of the seizure-free period on the relapse risk after antiseizure medication(ASM) withdrawal in epilepsy populations and identify the optimal timing of ASM withdrawal. METHODS: The Cochrane Central Register of Controlled Trials, PubMed and Web of Science were searched for literature published from inception to November 2, 2025. The primary outcome was the relapse risk of epilepsy patients after ASM withdrawal.…