Discontinuing Medication in Epileptic Children: A Study of Risk Factors Related to Recurrence

Gherpelli, José Luiz Dias; Kok, Fernando; Forno, S Dal; Elkis, L C; Lefèvre, Beatriz Helena; Diament, Aron Judka

doi:10.1111/j.1528-1157.1992.tb02347.x

Cited by 58 publications

(51 citation statements)

References 21 publications

(35 reference statements)

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“…That is because there is a co-linearity between them. This variable, which is an indicator of seizure severity before control, has been shown by other studies to be a predictive factor for seizure recurrence after AED withdrawal [19][20][21] . Other studies have demonstrated that this factor has shown only a tendency towards significance 22,23 .…”

Section: Discussionmentioning

confidence: 69%

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

Cardoso

Cendes

Guerreiro

2003

Arq. Neuro-Psiquiatr.

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-Objective: To investigate the value of leaving seizure-free patients on low-dose medication. Method: This was an exploratory prospective randomized study conducted at our University Hospital. We evaluated the frequency of seizure recurrence and its risk factors following complete or partial antiepileptic drug (AED) withdrawal in seizure free patients for at least two years with focal, secondarily generalized and undetermined generalized epilepsies. For this reason, patients were divided into two groups: Group 1 (complete AED withdrawal), and Group 2 (partial AED withdrawal). Partial AED withdrawal was established as a reduction of 50% of the initial dose. Medication was tapered off slowly on both groups. Follow-up period was 24 months. Results: Ninety-four patients were followed up: 45 were assigned to complete (Group 1) AED withdrawal and 49 to partial (Group 2) AED withdrawal. Seizure recurrence frequency after two years follow-up were 34.04% in group 1 and 32.69% in Group 2. Survival analysis showed that the probability of remaining seizure free at 6, 12, 18 and 24 months after randomization did not differ between the two groups (p = 0.8). Group 1: 0.89, 0.80, 0.71 and 0.69; group 2: 0.86, 0.82, 0.75 and 0.71. The analysis of risk factors for seizure recurrence showed that more than 10 seizures prior to seizure control was a significant predictive factor for recurrence after AED withdrawal (hazard ratio = 2.73). Conclusion: Leaving seizure free patients on low AED dose did not reduce the risk for seizure recurrence. That is, once the decision of AED withdrawal has been established, it should be complete.KEY WORDS: epilepsy, antiepileptic drug withdrawal, seizure recurrence, prognosis. Vale a pena manter baixas doses de droga antiepilética em pacientes com epilepsia controlada?RESUMO -Objetivo: Investigar o valor da manutenção de baixas doses de medicação em pacientes com epilepsia controlada. Método: Trata-se de um estudo prospectivo aleatorizado exploratório, realizado em nosso Hospital Universitário. Nós avaliamos a freqüência de recorrência de crises e os fatores de risco associados após a retirada parcial ou completa da droga antiepiléptica (DAE), em pacientes com crises controladas por pelo menos dois anos. Os pacientes foram divididos em dois grupos: Grupo 1 (retirada completa da DAE) e Grupo 2 (retirada parcial da DAE). Retirada parcial da DAE foi estabelecida como uma redução de 50% da dose inicial. A medicação foi retirada lentamente nos dois grupos. O período de seguimento foi de 24 meses. Resultados: Noventa e quatro pacientes foram seguidos: 45 foram selecionados para a retirada completa (Grupo 1) e 49 para a retirada parcial (Grupo 2). As taxas de recorrência de crises após dois anos de seguimento foram 34,04% para o Grupo 1 e 32,69% para o Grupo 2. A análise de sobrevivência mostrou que a probabilidade de permanecer livre de crises aos 6, 12, 18 e 24 meses após a aleatorização não diferiu entre os dois grupos (p = 0,8). Grupo 1: 0,89, 0,80, 0,71 e 0,69; Grupo 2: 0,86, 0,82, 0,75 e 0,71...

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Section: Discussionmentioning

confidence: 69%

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

Cardoso

Cendes

Guerreiro

2003

Arq. Neuro-Psiquiatr.

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“…Our study mainly concerns children with idiopathic epilepsy; many variables of predictive importance determined in earlier studies can be referred to epilepsies secondary to structural brain lesions. These variables include neurological abnormalities (3-7), a history of perinatal complications (16), and a high seizure frequency before initiation of treatment (3,5,23,25,26)variables not related to outcome in our study. The outcome of children with neurological impairments in our study (MMR and ADHD/DAMP) did not differ from that of children without such impairments (relapse rate 33% and 38%, respectively).…”

Section: Applying Our Data To Earlier Modelsmentioning

confidence: 92%

“…Almost all the studies performed in the last few decades (4,5,8,(17)(18)(19)27) have used a seizure-free period of at least 2 years as the cutoff point for discontinuation of treatment. Studies that analyzed outcome in relation to different seizure-free periods before treatment discontinuation have shown that the seizure-free period correlated positively to favorable outcome (9,25).…”

Section: Applying Our Data To Earlier Modelsmentioning

confidence: 99%

“…Many studies have focused on these issues, and different risk factors for poor prognosis have been recognized (1)(2)(3)(4)(5)(6). Several studies have shown that children with neurological abnormalities or severe forms of epilepsy, such as infantile spasms (IS) or Lennox-Gastaut syndrome (LGS) have poor prognoses in terms of seizure control (3)(4)(5)(6)(7). Other risk factors related to outcome, such as seizure type, age at seizure onset, and EEG abnormalities, have been identified, but the results of earlier studies are not unanimous (1,(6)(7)(8)(9).…”

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confidence: 99%

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Early Discontinuation of Treatment in Children with Uncomplicated Epilepsy: A Prospective Study with a Model for Prediction of Outcome

Braathen

Melander

1997

Epilepsia

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Summary: Purpose: The main purpose of the present study was to identify predictor variables with significant influence on seizure outcome after discontinuation of treatment in children with uncomplicated epilepsy and to analyze whether these variables, included in a prognostic model could identify children in whom 1‐year treatment would be sufficient. Methods: Before initiation of treatment in children aged 2–16 years with uncomplicated epilepsy, the duration of treatment was randomized to 1 year (group I) or 3 years (group II). At the end of the allotted period, treatment was discontinued in 161 children who had been seizure free during the previous 6 months. The mean follow‐up period after treatment was 5.8 years. Twenty‐three predictor variables were analyzed by survival methods regarding their influences on the outcome. Results: At the latest follow‐up check, 60 children (37%) had relapsed. The following predictor variables were selected by multiple regression analysis and constituted a model with a simple scoring system: age at seizure onset; seizure type; generalized, irregular spike‐wave activity on EEG after 1 year of treatment; and persistent 3‐Hz spike‐wave activity after 6 months of treatment in children with absence epilepsy. In group I, the remission rate was 73% in children with high prognostic scores, 10% in children with low scores, and 40% in those with intermediate scores (log‐rank test, p = 0.0001). Conclusions: After 1 year of treatment, our prognostic model identified children in whom treatment could be withdrawn at that time. Our model should be easily applicable in clinical practices and may be of clinical importance in determining the duration of treatment in children with uncomplicated epilepsy.

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“…the number of seizures before treatment, the total number of seizures, the time period from the initiation of treatment until the convulsions being under control, the duration of discontinuation and seizure relapse rates after AED withdrawal [5,14,22]. 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].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

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AbstractThere is no consensus regarding the time of antiepileptic drug withdrawal and the relevant risk factors for seizure relapse. In this study, we aimed to determine the seizure relapse rates and the associated risk factors for seizure relapse in childhood epilepsy. Two-hundred sixty-six epileptic patients who discontinued the antiepileptic drug therapy after a seizure-free period of at least two years, were enrolled into the study. The data of the patients regarding sex, febrile convulsion history, family history, age at onset, type of epilepsy, total number of seizures and antiepileptic drugs, seizures during treatment, mental status, first and last electroencephalography, brain imaging findings, etiological factors and seizure relapse in the first two years after antiepileptic drug withdrawal were obtained from the patients’ files. Univariate logistic regression analysis was performed for each variable. The variables which were found to be statistically significant in univariate analysis, were included in multivariate logistic regression analysis. The overall seizure relapse rate after antiepileptic drug withdrawal was 19.2%. There were no significant differences for seizure relapse rate after antiepileptic drug withdrawal between patient groups with respect to sex, family history, type of epilepsy, febrile convulsion history, seizures before treatment, first electroencephalography findings, brain imaging findings and etiology. However, there were statistically significant differences for seizure relapse rate among patient groups concerning age at onset of epilepsy, new seizure during treatment, the total number of antiepileptic drugs, mental status, and last electroencephalography findings. We imply that the clinical status of the patients should be considered before the cessation of drug therapy rather than the etiological factors or laboratory findings.

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Discontinuing Medication in Epileptic Children: A Study of Risk Factors Related to Recurrence

Cited by 58 publications

References 21 publications

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

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

Early Discontinuation of Treatment in Children with Uncomplicated Epilepsy: A Prospective Study with a Model for Prediction of Outcome

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

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