QLIF-11. WITHDRAWAL OF ANTIEPILEPTIC DRUGS IN GLIOMA PATIENTS AFTER LONG-TERM SEIZURE FREEDOM

Abstract

When glioma patients experience long-term seizure freedom the question arises whether antiepileptic drugs (AEDs) should be continued. We performed a prospective study on the decision-making process to withdraw AEDs in glioma patients with long-term seizure freedom, and on seizure outcome after withdrawal. Patients with a histologically confirmed low grade or anaplastic glioma were included. Patients eligible for the study were seizure free for ≥ 1 year counted from the date of last surgery, irradiation or chemotherapy, or ≥ 2 years since the last seizure after antitumor treatment. Primary outcome measures were: 1) the outcome of the shared-decision making process (i.e. AED withdrawal or continuation) and 2) the rate of successful AED withdrawal. Between January 2014 and December 2016, 83 patients fulfilled all eligibility criteria. In 12/83 (14%) of patients, the neuro-oncologist had serious objections to AED withdrawal. Therefore, 71/83 (86%) were included in the study. In 46/71 (65%) patients AEDs were withdrawn and in 25/71 (35%) AEDs were continued. Median follow-up was 2.0 years (range 0.8-3.8). Twenty-six percent (12/46) had seizure recurrence during-follow up; six of these twelve patients (50%) had tumor progression, of which three patients had tumor progression within three months after seizure recurrence. Median time of tumor progression after seizure recurrence is 8.5 months (range: 0.2-19 months). Eight patients had a focal seizure, three patients a generalized seizure and one patient had a complex-partial status epilepticus. In the AED continuation group, none of the patients had seizure recurrence. In this group one patient had tumor progression. Sixty-five percent of selected patients preferred to withdraw their AEDs, of which 26% had seizure recurrence. AED withdrawal should only be considered in carefully selected patients.