Discontinuing antiepileptic drugs in children with epilepsy: A prospective study

Abstract

In a prospective study, antiepileptic drugs were discontinued in 264 children with epilepsy after a mean seizure-free interval of 2.9 years. They were then followed for a mean of 58 months to ascertain whether seizures recurred. Seizures recurred in 95 (36%) of the children. Etiology was a significant predictor of outcome (relative risk [RR] = 1.81). On multivariable analysis, significant factors in the idiopathic group included age at onset above 12 years (RR = 5.4), a family history of seizures (RR = 3.1), the presence of slowing on the electroencephalogram prior to medication withdrawal (RR = 2.4), and a history of atypical febrile seizures (RR = 2.8). Specific epileptic syndromes such as juvenile myoclonic epilepsy and benign rolandic epilepsy were also significant predictors of outcome. In the remote symptomatic group, significant predictors of outcome included age at onset older than 12 years (RR = 3.6), moderate to severe mental retardation (IQ < 50) (RR = 2.8), a history of atypical febrile seizures (RR = 2.0), and a history of absence seizures (RR = 0.4). The majority of children with epilepsy in remission while on antiepileptic drug therapy will remain seizure free when medications are withdrawn. A few readily available parameters distinguish those with a good prognosis from those in whom seizures are likely to recur. These data provide the framework for the clinical decision making for withdrawal of medications in these children.

Determination of risk factors associated with seizure relapse after antiepileptic drug withdrawal

“…It has been reported that the overall seizure relapse rate was 23-71% in patients who did not receive any treatment after the first seizure and seizure relapse rates were higher in patients who had abnormal EEG findings and symptomatic epilepsy [23][24][25][26][27][28]. The relation between age at onset of epilepsy and seizure relapse rates have been investigated in several studies with contradictory results [10,11,29]. The children who had the first seizure before six year-old had higher rates of family history of epilepsy and febrile convulsion, but had lower seizure relapse rates after AED withdrawal [5].…”

“…Seizure relapse rates after AEDs withdrawal have been reported as 22.4-40.0% and 85-90% of all those relapses that occur in the first two years of withdrawal [10][11][12][13][14][15]. Accordingly, children should be followed closely during the first two years after AEDs withdrawal.…”

“…The most important point to withdraw antiepileptic drugs (AEDs) is the presence of a seizure free period of at least two years in an epileptic patient. The relapse rates in childhood-onset epilepsy have been reported as 22.4-40.0% after AEDs withdrawal [10][11][12][13][14]. Thus, determination of the risk factors for relapse after AEDs withdrawal is crucial to minimize the seizure relapse rates.…”

Epilepsy in the Elderly

“…This finding suggests that predisposition to epilepsy plays a role in persistent seizure recurrence as well as increased seizure propensity in old age. A family history of unprovoked seizures among the first-degree relatives has been reported to be associated with an increased risk of recurrence in children with idiopathic epilepsy (17).…”

Management of Childhood-onset Epilepsy Evaluated with a Long-term Follow-up Study

“…These facts suggest that patients who were apparently in remission at the time of our survey may include those who still have active epileptic mechanisms. In general, seizure outcome after stopping AEDs is favorable, especially in children (17,18). However, a small number of patients do not enter remission again despite treatment for relapse following a planned discontinuation of AEDs (19,20).…”