Objective To retrospectively analyze the risk factors for recurrence within 1 year after discontinuation of antiepileptic drugs (AEDs) in epilepsy patients, and to construct and validate a columnar diagram model for individualized prediction of recurrence risk. The aim is not only to provide decision-making assistance for clinicians but, more importantly, to offer a quantitative tool for nursing staff to identify high-risk patients, implement stratified management, and deliver precision interventions. Methods A retrospective study was conducted on 271 epilepsy patients treated at Beijing Tiantan Hospital, Capital Medical University, from October 2018 to October 2023, who ultimately attempted AED withdrawal. Patients were divided into a recurrence group (n=67) and a non-recurrence group (n=204) based on whether they experienced recurrence within 1 year after AED discontinuation. Key predictive factors were screened from candidate clinical variables using least absolute shrinkage and selection operator (LASSO) regression, followed by multivariate logistic regression analysis to identify independent risk factors. A columnar diagram predictive model was constructed based on these independent factors. Internal validation was performed using bootstrap repeated sampling (1000 times), and the model's discriminative power, calibration, and clinical utility were comprehensively evaluated by calculating the consistency index (C-index), plotting receiver operating characteristic (ROC) curves, calibration curves, and decision curve (DCA). Results LASSO regression and multivariate analysis ultimately identified three independent predictors: epileptiform discharges on electroencephalogram (EEG) (OR=3.15, 95%CI (1.72, 5.78)], presence of structural etiology [OR=2.89, 95%CI (1.51, 5.54)], and duration of epilepsy before drug withdrawal (≥5 years) OR=2.46, 95%CI (1.30, 4.66)]. The columnar diagram model constructed based on these predictors achieved a C-index of 0.786 [95%CI (0.728, 0.844)] in the original cohort. After internal validation, the adjusted C-index was 0.773. ROC curve analysis demonstrated an area under the curve (AUC) of 0.786. Calibration curves showed good consistency between predicted and observed probabilities, with a Hosmer-Lemeshow test P-value of 0.452. Decision curve analysis indicated that the model had clinical net benefit when applied within a threshold probability range of 2% to 58%, with the maximum net benefit observed at a threshold probability of approximately 30%. Conclusion This study established a columnar diagram model incorporating three readily available clinical indicators, enabling rapid calculation of individualized relapse risk during outpatient drug withdrawal assessments. The model identifies three core targets for nursing stratification (EEG discharges, structural etiology, and long disease duration), providing objective evidence for transitioning from "routine education" to "risk-based precision intervention" for nursing staff. This approach contributes to optimizing the entire withdrawal process management and enhancing patient safety.
ObjectiveTo explore the real experiences of women of childbearing age with epilepsy during their reproductive decision-making process, and to provide a basis for clinical practitioners in managing the reproductive decision-making of this group of women and implementing decision support. MethodsSixteen women of childbearing age with epilepsy who were hospitalized in the Epilepsy Center of Beijing Tiantan Hospital, Capital Medical Universityi in Beijing from April 2024 to June 2024 were selected through purposive sampling. The Colaizzi phenomenological data analysis method was employed, and the data were organized and analyzed with the aid of Nvivo 11.0 software to extract themes. ResultsThree themes and eight sub-themes were extracted: The majority of patients had reproductive demands (personal role expectations, family and social pressure), Uncertainties in reproductive behaviors and outcomes (uncertainties in the pregnancy process caused by the disease, uncertainties in the reproductive outcome caused by the disease), and Encountering reproductive decision-making predicaments (lack of professional knowledge, conflicting information from different channels, multiple factors influencing reproductive decision-making, and various negative experiences associated with decision-making). ConclusionThe majority of women of childbearing age with epilepsy have reproductive needs and encounter decision-making predicaments. Medical staff should pay attention to their true experiences, offer adequate support and assistance, and help patients extricate themselves from the decision-making predicament to make scientific and rational decisions.
Objective To evaluate the risk factors for seizure recurrence after withdrawal in adult patients with focal epilepsy who have been seizure-free for more than 3 years following drug treatment. Methods This study retrospectively included cases of adult patients with focal epilepsy treated with antiepileptic drugs at the outpatient department of Beijing Tiantan Hospital between January 2018 and October 2024. The chi-square test (or Fisher’s exact test) and logistic regression analysis were used to explore risk factors for seizure recurrence after withdrawal. Results This study analyzed 397 patients with focal epilepsy who maintained seizure-free for more than 3 years with complete clinical data. Among them, 286 patients maintained seizure-free without medication reduction, 2 patients did not reduce medication but experienced recurrence, 73 patients experienced recurrence after medication reduction, and 36 patients remained seizure-free after medication reduction. Among 109 patients with focal epilepsy who withdrew medication after more than 3 years of seizure freedom, 73 (66.97%) experienced recurrence. Univariate analysis revealed no significant correlation between gender, age at onset, comorbidities, or number of antiepileptic drugs and post-withdrawal recurrence (all P > 0.05). Shorter seizure-free duration and abnormal brain MRI findings were identified as risk factors for recurrence after withdrawal (P<0.05). Multivariate logistic regression analysis confirmed that seizure-free duration<4 years and abnormal intracranial lesion were independent risk factors for post-withdrawal recurrence (P<0.05). Conclusions Shorter seizure-free duration and abnormal intracranial lesion are risk factors for seizure recurrence after withdrawal in adult patients with focal epilepsy who have been seizure-free for≥3 years.