Outcome After Discontinuation of Antiepileptic Drug Therapy in Children with Epilepsy

Abstract

We studied recurrence risks and predictive factors of relapse after antiepileptic drug (AED) discontinuation in a prospective analysis of 425 children with epilepsy who had not had a seizure for at least 2 years (follow-up after withdrawal 1.6-12 years, mean 8 years). Factors closely related by multivariate analysis to relapse were neurologic abnormalities, mental retardation, seizure type (infantile spasms, absence seizures), and appearance or persistence of EEG abnormalities during the course of the illness and before discontinuation. When multivariate analysis was performed to evaluate outcome of patients with a first relapse (isolated vs. multiple relapses), the variables closely related to a poor prognosis were etiologic factors, first relapse characterized by more than one seizure in a 24-h period, seizure-free period less than 4 years, unchanged seizure type at first relapse, more than one AED for seizure control, and abnormal EEG before the first relapse. In itself, resumption of therapy did not influence outcome. At the study cutoff point, 88% of patients with relapse were again seizure-free. We conclude that AEDs can safely be discontinued if predictive factors are considered to individualize the risk of relapse for each patient.

Prognosis after Therapy Discontinuation in Children with Epilepsy

“…Furthermore, it can be confirmed [10,12,14,19,20,25] that the vast majority of relapses occur within the 1st year after discontinuation (84% of our cases) and almost all within the 2nd year (93.3%); in this present series, only 3 patients relapsed after the 2nd year.…”

“…This time limit of 2 years is considered sufficient by some [10,14,[19][20][21] and not enough by others [11][12][13]15]. The percentage of recovery in our cases (77.5%), which in itself is already very high, would be higher still, if, in the present series, we had included (as in fact many other authors have done) partial benign epilepsies whose natu ral course is favorable and which we normally treat only in particular cases; for this reason we have excluded them from this study which specifically considers AED discon tinuation.…”

“…We proceed gradually over 6 months to the dis continuation of therapy (a quarter of the dose each time; if a patient was receiving more than one medication, one drug was completely stopped before tapering of the next was begun) [10,13,14], In cases where this program was carried out with the parents' consent, the percentage of relapses was 18%; when therapy was withdrawn over a shorter period of time (more often interrupted suddenly by the parents or by the patient himself), the recurrence rate rose to 40%. in agreement with Todt [ 12], In our patients, pathological EEG records, whether during active illness or during withdrawal, do not repre sent risk factors for the prognosis.…”

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

“…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).…”

“…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).…”