Discontinuing Antiepileptic Medication in Children with Epilepsy after Two Years without Seizures

Abstract

Antiepileptic medications were discontinued in 88 children with epilepsy of various causes who had been free of seizures for two to four years. The subjects were then followed for six months to five years (mean, 22 months). Sixty-six (75 per cent) remained free of seizures. Electroencephalographic characteristics, type of seizure, and age at onset were important in predicting outcome. Specific electroencephalographic features (such as the presence or absence of slowing or spikes) were more predictive than simple classification of an electroencephalogram as normal or abnormal. A history of complex partial seizures that had been controlled for two years carried a relatively favorable prognosis (P less than 0.05), whereas a history of atypical febrile seizures carried a poor prognosis (P less than 0.05). The variable of a younger age at onset was also associated with a better outcome (P less than 0.05), but only if accompanied by electroencephalographic slowing. Altogether, six variables (the interaction of age at onset with electroencephalographic slowing, electroencephalographic spikes, atypical febrile seizures, complex partial seizures, electroencephalographic slowing, and electroencephalographic change) were statistically significant (P less than 0.05) in predicting outcome. We conclude that in most children with epilepsy who have been free of seizures for two or more years, antiepileptic medications can safely be discontinued, and that it is possible to predict reasonably well which children will remain free of seizures.

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

“…Berg and Shinnar reported that the epilepsies, which began before 12 years od age, had higher rate of seizure relapse risk than those after 12 years of age [30]. Shinnar et al also reported that the mean age of epilepsy was 6.9 years in patients who had seizure relapse and 4.3 years in patients who did not have seizure relapse [31]. In our study, we found that age at theonset of epilepsy (especially >5 years), the total number of seizures (especially >5 seizure), new seizure during treatment, and the need for polytherapy were important risk factors for seizure relapse after AEDs withdrawal.…”

Sensitivity and Specificity of Electroencephalography (EEG) Among Patients Referred to an Electrophysiology Lab in Bangladesh

“…We had a similar yield of abnormal report in EEG. There is wide variation in sensitivity (23%-77%) and specificity (24%-99%) of reported EEG in general population [58][59][60][61][62][63][64][65][66][67] . Donald L et al 68 concluded three important findings related to wide variation in sensitivity and specificity of EEG.…”

Is low antiepileptic drug dose effective in long-term seizure-free patients?

“…Other studies have demonstrated that this factor has shown only a tendency towards significance 22,23 . Moreover, others showed no relationship between number of seizures prior to seizure control and increased recurrence risk for seizure recurrence after discontinuation of AED [24][25][26] . However, the importance of these studies might be limited to patients at tertiary epileptic centers, since seizures are easily controlled in a great majority of the patients with recently diagnosed epilepsy 7 .…”