Analysis of the short-term outcomes and risk factors of seizure relapse in patients with gliomas after antiepileptic drugs withdrawal

Abstract

The optimal timing for glioma patients to stop taking antiepileptic drugs (AEDs) and the risk factors of seizure relapse have not been determined. Here, we explored the short-term outcomes and risk factors of seizure relapse in glioma patients after withdrawal of AEDs. 91 patients with gliomas who had no seizures at least 2years after surgery were enrolled in the study. The patients were followed up for 1year or until the relapse of seizure after AEDs withdrawal. The risk factors of seizure relapse were analyzed by univariate and multivariate analysis. The optimal discrimination point was determined by plotting a receiver operating characteristic (ROC) curve to explore the relationship between the number of risk factors and seizure relapse. 28 patients (30.8%) relapsed during the follow-up period while 63 patients (69.2%) remained seizure-free. Of the 28 relapsed patients, 20 (71.4%) relapsed within the first 6months after the AEDs withdrawal. Multivariate analyses revealed that subtotal resection (p=0.026), IDH1 mutation (p=0.019), and combined use of AEDs (p=0.037) were independent risk factors for seizure relapse in glioma patients. ROC curve based on the seizure relapse showed that the sensitivity was 0.821 and 1-specificity was 0.238, corresponding to 1.5 independent risk factors for each patient. To obtain a favorable outcome for glioma patients with preoperative seizures, only patients with less than two independent risk factors for seizure relapse should consider discontinuing AEDs.