Risk of recurrence after discontinuation of antiepileptic drug therapy in children with epilepsy

Abstract

Objectives:The numerous antiepileptic drug (AED) withdrawal studies published in the last 40 years have relied mainly on heterogeneous study groups. There is still no general agreement on the criteria to predict safe discontinuation. The goal of this study was to assess the outcome of AED withdrawal in epileptic children.Materials and Methods:Three hundred and eight children with epilepsy were enrolled, and these patients followed at least 1 year after drug withdrawal. Time to seizure relapse and predictive factors were analyzed by survival methods.Results:Among the 308 patients, 179 (58.1%) were boys and 129 (41.9%) were girls and the mean age at the seizure onset was 60.41 ± 36.54 months (2-144 months). The recurrence occurred in 73 (23.7%) patients. Mental retardation, history of febrile seizure, etiological of epilepsy, abnormal first electroencephalogram (EEG), abnormal neuroimaging findings, and total number of AED before remission were significantly associated with relapse risk according to univariate analysis. In the multivariate analysis, abnormal first EEG and number of AED before remission (polytherapy) were the risk factors influencing seizure recurrence.Conclusions:In our study, recurrence rate was 23.7% in children and most occurred during the 1st year. The potential risk factors of recurrence are history of febrile seizure, mental retardation, etiological of epilepsy, abnormal first EEG, abnormal neuroimaging findings, and total number of AED before remission. However, we found abnormal first EEG and polytherapy as risk factors of recurrence in multivariate analysis.

Risk factors for recurrence after drug withdrawal in childhood epilepsy

“…A family history of epilepsy was reported as a risk factor for recurrence in patients with idiopathic epilepsy by Shinnaret al [15]. We did notfind it to be a risk factor for recurrence, which is consistent with some studies [10,27]. A history of febrile convulsions has been reported previously not to be a recurrence riskfactor, as in our study [9,10,16].…”

“…But there are also controversial studies [8,27]. Cognitive impairment has been found to be a significant risk factor for recurrence [17,27], but in our study no correlation was found as in previous studies [8,10,29]. Conflicting results have been reported about the role of abnormalities on EEG in predicting recurrence.…”

“…In our study, according to the aetiological epilepsy classification, the recurrence rate was higher for the structural-metabolic and unknown group than for the genetic group. In the literature, as in our results, the remote symptomatic epilepsy group was most significantly related to higher relapse rates compared with the idiopathic group [15,19,27]. However, no difference was found in some studies [9,10,28].…”

“…A history of febrile convulsions has been reported previously not to be a recurrence riskfactor, as in our study [9,10,16]. But there are also controversial studies [8,27]. Cognitive impairment has been found to be a significant risk factor for recurrence [17,27], but in our study no correlation was found as in previous studies [8,10,29].…”

Prognostic analysis of patients with epilepsy according to time of relapse after withdrawal of antiepileptic drugs following four seizure‐free years

“…3,4,25 In terms of EEG, abnormal EEG findings have been reported to have a modest impact on recurrence. 16,26,27 However, the EEG variable was not identified as a prognostic covariate in this study.…”