Risk of recurrence after antiepileptic withdrawal: Was it a good decision or not?

Ozlem Yayici Koken; Ayse Aksoy; Ozge Kucur; Mehpare Kafali

doi:10.18502/cjn.v20i2.6743

Ozlem Yayici Koken Department of Pediatric Neurology, Ankara City Hospital, Ankara, Turkey
Ayse Aksoy Department of Pediatric Neurology, Ondokuz Mayis University, Samsun, Turkey
Ozge Kucur Department of Pediatric Neurology, University of Health Sciences, Dr. Sami Ulus Research and Training Hospital, Ankara, Turkey
Mehpare Kafali Department of Pediatric Neurology, WM Medical Park Pendik Hospital, Istanbul, Turkey

DOI: https://doi.org/10.18502/cjn.v20i2.6743

Keywords: Recurrence; Central Nervous System Diseases; Epilepsy; Therapeutics; Seizures

Abstract

Background: The aim of this study was to identify the demographic-clinical variables affecting idiopathic epilepsy (IE) [called genetic generalized epilepsy (GGE)] recurrence and determine cut-off values that can be used in pediatric neurology practice for children with IE/GGE.

Methods: A total of 250 children and adolescents with IE/GGE were included and retrospectively evaluated. The patients’ hospital records were examined in order to identify possible electro-clinical features affecting epilepsy recurrence.

Results: The overall rate of recurrence in the patients was 46%; the age at onset of seizures in recurrence group was lower (P = 0.040) and the age at last seizure was higher in the recurrence group (P < 0.001) than that in the non-recurrence group. Other factors found to be related to recurrence were the shorter duration of the seizure-free period (P = 0.030), shorter interval between the last seizure and antiepileptic drug (AED) withdrawal (P = 0.003), shorter duration of AED withdrawal (P = 0.005), and the existence of abnormalities on sleep electroencephalogram (EEG) during AED withdrawal (P = 0.010) and at the 6^th month of withdrawal (P < 0.001). According to receiver operating characteristic (ROC) analysis, the risk of IE recurrence was higher in children who were younger than 3.6 years old (sensitivity: 65.6%, specificity: 62.7%), children with a seizure-free period that was shorter than 35.5 months (sensitivity: 89.6%, specificity: 32.8%), and children whose drug withdrawal period was shorter than 4.5 months (sensitivity: 56.3%, specificity: 71.6%).

Conclusion: This study defined some electro-clinical factors that could guide clinicians when deciding to withdraw AEDs with regard to recurrence risk after evaluating a homogenous population of children with a diagnosis of IE/GGE.