Risk of recurrence after drug withdrawal in childhood epilepsy

Ölmez, Akgün; Arslan, Ümüt; Turanlı, Güzide; Aysun, Sabiha

doi:10.1016/j.seizure.2008.10.011

Cited by 42 publications

(73 citation statements)

References 21 publications

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“…In previous studies, 85-90% of recurrences were also reported within 2 years. [2310] We found the relapse rate is highest in the 1 st year, with a lower incremental rate after the 2 nd year. In the first 6 months, the recurrence rate was 61.7% after the withdrawal, 26.0% was after 6-12 months and 8.3% in the 12-24 months, and 4.0%) was after 2 years period.…”

Section: Discussionmentioning

confidence: 74%

“…They found that 12 patients (6%) had recurrence in the first 3 months after the withdrawal, 16 (8%) had in the 3-9 months period, 10 (5%) had in the 9-15 months period, 2 (1%) had in the 15-24 months period, and 14 (7%) had recurrence after 2 years. [10] In another study, Hindley and Staniforth reported recurrence rate as 32.4% and that cumulative relapse rates were 53.3% of children within 6 months, 66.7% during the 1 st year and 90% within 3 years in their study. [11]…”

Section: Discussionmentioning

confidence: 98%

“…[21011] However, there is still no consensus concerning the conditions for discontinuation of AED in children. Therefore, this study was designed to identify the risk factors associated with recurrence after AED withdrawal in children with epileptic seizures.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 98%

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

et al. 2014

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“…Another situation, also common in childhood epilepsy, is the risky period of tapering the anti-epileptic medication after 2 years of seizure freedom. Although there is no evidence-based knowledge on the length of the tapering period [36], it is well known that withdrawal of anti-epileptic medication should be done slowly and gradually in order to minimize the risk of breakthrough seizures [5,31].…”

Section: When Do Convulsive Seizures Occur?mentioning

confidence: 99%

Clinical practice

Lagae

2011

Eur J Pediatr

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An adequate early treatment of a long-lasting convulsive seizure is critical in reducing potential morbidity, and in particular, brain damage. In pre-hospital settings the use of benzodiazepines should become standard. Nowadays, rectal diazepam is used frequently, but midazoloam and lorazepam are becoming more popular, both being given either intranasally or orally. The buccal route is to be preferred because of its easy use and high efficacy. A generally accepted policy for early treatment of convulsive seizures is a crucial issue in the elaboration of an overall treatment plan for the child with epilepsy. Such a plan should include instruction and education of the parents and the caregivers surrounding the child.

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“…Approximately 30% will be unable to discontinue treatment because of a recurrence of their seizures [4][5][6]. Medication is often restarted and nearly half of the children will become seizurefree a second time, prompting clinicians to consider a second attempt to withdraw AEDs [7].…”

Section: Introductionmentioning

confidence: 99%

What do epileptologists recommend about discontinuing antiepileptic drugs for a second time in children?

McCarthy

Camfield

et al. 2015

Epilepsy & Behavior

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Risk of recurrence after drug withdrawal in childhood epilepsy

Abstract: Although the decision to discontinue AED treatment necessitates evaluation of each patient individually, our study suggests that female patients and those with abnormal EEG after withdrawal require more cautious follow-up because of the high risk of recurrence.

Cited by 42 publications

References 21 publications

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

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

Clinical practice

What do epileptologists recommend about discontinuing antiepileptic drugs for a second time in children?

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