Risk factors for seizure recurrence after antiepileptic drug withdrawal in children with epilepsy

Hilal Meteris, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Pediatrics -Bursa, Turkey
Arzu Ekici, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Pediatrics, Division of Neurology -Bursa, Turkey

Introduction and Objectives: The most common queries from families after an epilepsy diagnosis are, “When will the medication be discontinued?” and “Will it recur?”. This study aims to evaluate the risk factors for seizure recurrence after antiepileptic drug (AED) withdrawal in children with epilepsy. Methods: Patients aged between one month and 18 years who were diagnosed with epilepsy, had been seizure-free for at least two years, and whose last two electroencephalogram (EEG) tests normal were included in the study. Results: The study encompassed a total of 297 patients. Seizures recurred in 43 individuals (14.5%) following the discontinuation of AEDs. The average length of time before seizure recurrence was five months (range: one to 18 months). No statistically significant relationship was observed between seizure recurrence and variables such as gender, age, seizure type, age at seizure onset, epilepsy etiology, abnormal initial EEG, cognitive impairment, or coexisting neurological conditions (p = 0.158, p = 0.537, p = 0.184, p = 0.863, p = 0.744, p = 0.944, p = 0.702, p = 0.592, respectively). Factors such as monotherapy or polytherapy, prior AED usage before discontinuation, and the length of time AEDs had been discontinued did not show a significant impact on seizure recurrence (p = 0.297, p > 0.05, p = 0.155, p = 0.687, respectively). Conclusion: In this study, seizure recurrence occurred in 14.5% of patients after AEDs were discontinued. The ability to predict seizure recurrence in individual patients seems challenging. Therefore, maintaining close monitoring during the first two years following AED discontinuation is deemed crucial for effective management.

Keywords: Antiepileptic drug. Children. Epilepsy. Seizure recurrence. Risk factor.