- When antiepileptic drug (AED) therapy was withdrawn in children with epilepsy, recurrence risk was elevated for those with structural-metabolic or unknown types of epilepsy and those having a shorter seizure-free period.
Why this matters
- Optimal timing of AED withdrawal is unknown.
- With mean duration of follow-up of 8.3 (range, 3-17) years after AED withdrawal, incidence of recurrence was 18%.
- The majority of recurrences (64.7%) occurred in the first year.
- Incidence by electroclinical syndrome classification:
- Highest by far in the juvenile myoclonic/absence group (57%).
- Lowest in the benign infantile seizure group (5%) and the infantile spasm/West syndrome group (0%).
- Multivariate predictors of recurrence:
- Structural-metabolic or unknown epilepsy vs genetic (HR, 2.15; P=.009).
- Seizure-free period before AED withdrawal
- Factors not significantly predicting recurrence included sex, age of epilepsy onset, history of febrile convulsions, family history of epilepsy, cognitive impairment, number of AEDs.
- Turkish single-centre retrospective cohort study of 284 children with epilepsy onset between 1 month and 16 years of age, seizure free ≥2 years before AED withdrawal, follow-up ≥3 years after AED withdrawal.
- Main outcome: epilepsy recurrence.
- Funding: None disclosed.
- Unmeasured and residual confounding.
- EEGs not performed after AED withdrawal.
- Unknown generalisability.