Discontinuing anti-epileptic medication(s) in epileptic children: 18 versus 24 months

Abstract

For a period of slightly over 4 years, 80 children who had been seizure-free for at least 18 months while on anti-convulsant medication were prospectively collected. These 80 children were randomly assigned to either the 18-months seizure-free group (n 5 41) or to the group where anti-convulsant medications were continued for another 6 months before they were gradually tapered off and stopped, i.e. the 24-months seizure-free group (n 5 39). Twelve (29%) of the 41 children who had been seizure-free for 18 months and 14 (36%) of the 39 children who had been seizure-free for 24 months had seizure recurrence during the follow-up period. Log-rank test of the recurrence experience of the two groups of patients showed no statistically signi® cant difference between the groups (p . 0.50). Similarly, when both groups were combined and other risk variables likely to in¯uence the rate of seizure recurrence were tested, only EEG abnormality at discontinuation of anti-convulsant medication had a signi® cant association with the risk of seizure recurrence (p , 0.001).

Seizure relapse based upon withdrawal period of antiepileptic drugs in pediatric epilepsy patients

“…Braathen study group [18] showed RR 1.64 (M-H Random 95% CI: 1.08-2.47); Tennison study group [19] showed RR 0.87 (M-H random 95% CI: 0.58-1.29); Todt 1984 showed RR 1.69 (M-H random 95% CI: 1.29-2.21); Gebremariam study [20] showed RR 0.82 (M-H random 95% CI: 0.43-1.54); Peters study group [21] showed RR 1.12 (M-H random 95% CI: 0.83-1.50); Verrotti study group [23] showed RR 1.16 (M-H random 95% CI: 0.58-2.30).…”

“…Braathen study group [18] showed RR 1.23 (M-H random 95% CI 0.86-1.76); Tennison et al [19] showed RR 1.55 (M-H random 95% CI 0.80-3.01); Todt group [22] showed RR 2.24 (M-H, random 95% CI 1.64-3.06); Two trials Gabrimariam et al, [20] Peters et al [21] have reported relapse risk without providing any data on total number of subjects in each group.…”

“…All drugs were tapered during a 3-month period After 3 years of seizure freedom. All drugs were tapered during a 3-month period Seizure relapse and risk factors including seizure type, serum concentrations of seizure drug Gebremariam et al [20] 1999 After an 18 seizure-free months After 24 seizure-free months Seizure relapse and risk factors including multiple medications, neurological deficit, family history of epilepsy, EEG, mental retardation Peters et al [21] 1998 After 6 months of seizure freedom. Withdrawal of drug was conducted over a period of 4 weeks in both groups After 12 months of seizure freedom.…”

“…In this study, EEG and drug tapering were the main interventions. [19] Three trials Gebremariam et al, [20] Peters et al, [21] Verrotti et al [23] studies had 2 years of follow-up periods, outcome was measured continuously in all studies, but presented as an aggregated number of individuals who had a seizure relapse at fixed time point depending on the follow-up duration of trial. Another study conducted by Gherpelli et al [24] assigned 70 children, experienced at least 2 seizures before the age of 12 years excluding neonatal seizure and febrile seizure.…”

Epilepsie im Kindesalter: Wann kann die antiepileptische Therapie abgesetzt werden?

“…Das Cochrane Review von Sirven et al [15] berück-sichtigt 7 prospektiv randomisierte Studien mit insgesamt 924 Kindern [4,8,11,17,18]. Drei der 7 Studien behandeln die gleiche Patientengruppe [3][4][5].…”