Pediatric epilepsy: risk factors for recurrence after AED withdrawal

  • Karalok ZS & al.
  • Brain Dev
  • 11.09.2019

  • von Susan London
  • Clinical Essentials
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Takeaway

  • When antiepileptic drug (AED) therapy was withdrawn in children with epilepsy, recurrence risk was elevated for those with structural-metabolic or unknown types of epilepsy and those having a shorter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.

 Key results

  • 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.

Study design

  • Turkish single-center 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.

Limitations

  • Unmeasured and residual confounding.
  • EEGs not performed after AED withdrawal.
  • Unknown generalizability.