Risk of recurrence after antiepileptic withdrawal: Was it a good decision or not?

Abstract

Background: The aim of this study was to identify the demographic-clinical variables affecting idiopathic epilepsy (IE) [called genetic generalized epilepsy (GGE)] recurrence and determine cut-off values that can be used in pediatric neurology practice for children with IE/GGE.
 Methods: A total of 250 children and adolescents with IE/GGE were included and retrospectively evaluated. The patients’ hospital records were examined in order to identify possible electro-clinical features affecting epilepsy recurrence.
 Results: The overall rate of recurrence in the patients was 46%; the age at onset of seizures in recurrence group was lower (P = 0.040) and the age at last seizure was higher in the recurrence group (P < 0.001) than that in the non-recurrence group. Other factors found to be related to recurrence were the shorter duration of the seizure-free period (P = 0.030), shorter interval between the last seizure and antiepileptic drug (AED) withdrawal (P = 0.003), shorter duration of AED withdrawal (P = 0.005), and the existence of abnormalities on sleep electroencephalogram (EEG) during AED withdrawal (P = 0.010) and at the 6th month of withdrawal (P < 0.001). According to receiver operating characteristic (ROC) analysis, the risk of IE recurrence was higher in children who were younger than 3.6 years old (sensitivity: 65.6%, specificity: 62.7%), children with a seizure-free period that was shorter than 35.5 months (sensitivity: 89.6%, specificity: 32.8%), and children whose drug withdrawal period was shorter than 4.5 months (sensitivity: 56.3%, specificity: 71.6%).
 Conclusion: This study defined some electro-clinical factors that could guide clinicians when deciding to withdraw AEDs with regard to recurrence risk after evaluating a homogenous population of children with a diagnosis of IE/GGE.

What are the predominant predictors of seizure relapse following discontinuation of anti‐seizure medication in epileptic children?

“…A comparison of predictors of seizure relapse following discontinuation of ASM in 12 previous pediatric studies and in our study is presented in Table 5 5,6,10–18 . The presence of febrile seizures and neonatal seizures has been reported as a predominant risk factor for seizure relapse 5,11,15–17 .…”

“…A comparison of predictors of seizure relapse following discontinuation of ASM in 12 previous pediatric studies and in our study is presented in Table 5. 5,6,[10][11][12][13][14][15][16][17][18] The presence of febrile seizures and neonatal seizures has been reported as a predominant risk factor for seizure relapse. 5,11,[15][16][17] In several studies, a history of febrile seizures has been declared as a predictive factor of seizure relapse, although it has been reported as insignificant in some cohorts and in our study.…”

“…Based on previous studies, 5,6,10–18 18 evidence‐based risk factors with statistical significance for seizure relapse following discontinuation of ASM were evaluated in the present study: (1) gender, (2) age at epilepsy diagnosis, (3) etiology, (4) diagnosis of self‐limited epilepsy syndrome, (5) abnormal neurological examination, (6) intellectual disability, (7) abnormal neuroimaging, (8) seizure type, (9) multiple seizure semiology, (10) seizure after ASM initiation, (11) number of ASM, (12) electroencephalography (EEG) prior to ASM discontinuation, (13) duration of withdrawal process (≤3 or >3 months), (14) seizure‐free period on therapy, (15) history of febrile seizures, (16) status epilepticus, (17) history of neonatal encephalopathy with or without seizures, and (18) family history of epilepsy.…”

“…Based on previous studies, 5,6,[10][11][12][13][14][15][16][17][18] League Against Epilepsy (ILAE) Classification of Seizures guideline was used to classify the seizure types. 19 A history of febrile seizures or epilepsy in first-or second-degree relatives was considered as a positive family history of febrile seizure or epilepsy.…”

“…The mean duration of ASM was 3.5 ± 1.9 (2-14) years. The average age at the discontinuation of ASM was 10.4 ± 4.02 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) years. The mean duration of follow-up after ASM discontinuation was 38 ± 30.4 months.…”