Reducing antiepileptic medication during a multiple-day video-EEG to investigate the feasibility of epilepsy surgery: what is the best way (safest and most efficious) to reduce antiepileptic drugs?

Rationale: In people with refractory epilepsy, long-term video-EEG monitoring (LTM) is a valuable tool to evaluate eligibility for epilepsy surgery. For many patients, anti-epileptic drugs (AEDs) are tapered during LTM, but safety concerns have been raised. AED withdrawal might be related to increased complications among which status epilepticus, whilst efficacy has not been established.

Objective: to study the safety and efficacy of AED withdrawal in LTM.

Study design: prospective observational multi-centre study

Study population: children and adults undergoing LTM in the evaluation for epilepsy surgery.

Main study parameters/endpoints: the efficacy endpoint is reached when a sufficient number of habitual seizures have been recorded. Safety is defined by the presence of complications, with any of the following items: status epilepticus (defined as a seizure lasting ¡Ý 5 minutes), seizure clustering (¡Ý 3 seizures in 4 hours), falls and physical injuries, postictal psychosis, generalized tonic-clonic seizures in patients without prior occurrence of these, cardio-respiratory distress, or acute medical complications requiring intervention.

Combining factors will enable prediction of successful long-term video-EEG monitoring and of adverse effects, related to antiepileptic drug withdrawal.

Baseline, during LTM and four weeks after

Not applicable