Discontinuation of anti-epileptic therapy: A retrospective study of 86 children and adolescents

Abstract

In order to identify any predictive factors of relapse after the discontinuation of anticonvulsive therapy, a catamnestic study was made of 86 epileptic children and adolescents who had started or completed the withdrawal of AEDs. Their clinical records were examined retrospectively, and univariate analysis showed that the factors which correlated significantly with a higher relapse rate were the age at the time of reducing treatment, the presence of more than 30 generalised or partial tonic-clonic seizures, the presence of febrile seizures, the duration of the active phase of the disease, the duration of therapy, and the coexistence of more than one type of seizure. At multivariate analysis, only the presence of 30 generalised or partial tonic-clonic seizures and febrile seizures were significant. Given the small size of the diagnostic subgroups, no significant correlation could be demonstrated between epileptological diagnosis and the risk of recurrence.

Seizure relapse following medication withdrawal in childhood epilepsy

“…Cumulative relapse rates were 53.3% of children within 6 months, 66.7% during the first year and 90% within 3 years. Our findings agree with those of Matricardi et al 3 who found that 30% of those who will relapse will do so during weaning (up to 6 months), 75% will do so during the first year and 98% will do so within 3 years.…”

Uncontrolled epilepsy following discontinuation of antiepileptic drugs in seizure-free patients: a review of current clinical experience

“…Arts et al outcome after relapse (11,123). Intriguingly, treatment of a recurrence was not a predictive factor for a better seizure outcome (126).…”

Discontinuation of AEDs: When and how?

“…The role of EEG in antiepileptic drug withdrawal is controversial. Although an abnormal EEG before drug withdrawal was a negative prognostic factor in many studies [24,25,28], the predictive value of EEG has not been confirmed universally [11,20,28]. In one study, patients with an abnormal EEG before drug withdrawal were twice as likely to relapse than were patients with a normal EEG [25].…”

“…Furthermore, the best evidence from the earlier literature comes from a large and frequently cited study, (MRC Antiepileptic Drug Withdrawal Group) [22], where patients randomized to continued treatment showed a 22% relapse at 2 years, while patients randomized to slow drug withdrawal had 41% relapse. In addition, several useful, but non-randomized observational studies [23][24][25] have provided us with a meaningful data. More importantly, in a meta-analysis of 25 studies by (Berg and Shinnar) , the pooled relapse risk was only 25% (95% CI, 21% -30%) at 1 year and 29% (95% CI, 24% -34%) at 2 years [26].…”

“…In general, patients with symptomatic or cryptogenic epilepsy fare less well than patients with idiopathic epilepsy as far as the prognosis for seizure control is concerned [32,33]. Therefore, withdrawal of antiepileptic drugs in patients with symptomatic or cryptogenic epilepsy is less likely to be successful [8,14,16,23,24]. In one study, the relapse rate in patients with symptomatic epilepsy was 45%, compared with 25% in those with idiopathic epilepsy [27].…”