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Withdrawal of antiepileptic drugs (AED) is routinely performed during long-term video-EEG monitoring to precipitate seizures. Some AEDs may need to be withdrawn more cautiously. It has been established that carbamazepine (CBZ) withdrawal in the epilepsy monitoring unit (EMU) is associated with more severe generalized tonic-clonic seizures (GTCS) than withdrawal of other classic AEDs.1,2 We studied the propensity of the CBZ analog oxcarbazepine (OXC) to precipitate withdrawal GTCS.
Methods.
We identified all patients with definite epilepsy admitted to our EMU on OXC or phenytoin (PHT) monotherapy, over a period of 6 years. The choice of PHT as control group was based on studies suggesting that the increase in seizures following its withdrawal is related to loss of efficacy rather than a rebound phenomenon.1,3 For most of the patients on OXC (31/40 or 77.5%), medication taper was performed over 24 hours by reducing the dose in half on admission day then stopping it the next day. The remaining OXC patients and all patients on PHT had their AED stopped on admission day. For each patient, we recorded the preadmission GTCS frequency as well as the total and daily number of GTCS recorded in the EMU. We calculated the EMU GTCS frequency by dividing the number of GTCS in the EMU by the number of EMU days, then multiplying by 30. We compared EMU GTCS …
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