Analysis of the factors of recurrence after discontinuation of antiepileptic drugs in the first year in children with idiopathic epilepsy_Journal of Epilepsy

Authors：

 FUXiafei ,  HANYunli

Department of Pediatrics, First Affiliated Hospital of Guangxi Medical University, Nanning 530000, GuangXi, China;

Corresponding author：

HANYunli, Email: zhonghanyunli@163.com

Keywords：

Idiopathic Epilepsy; Children; Antiepileptic drugs; Withdrawal; Recurrence; Risk factors

DOI：

10.7507/2096-0247.20160005

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Objective To observe the children with idiopathic epilepsy who received AED therapy and seizure-free, withdrawal at least 1 year, and analyze the risk factors of seizure recurrence. In order to give better instructions for AED withdrawal of children with idiopathic epilepsy in pediatric department. Methods Children with idiopathic epilepsy who were seizure-free and had stopped AED treatment at least 1 year before the deadline of observation were collected from pediatric outpatient and inpatient department of the First Affiliated Hospital of Guangxi Medical University from January 2011 to January 2014. The following variables, derived from the case records were analyzed: sex, age at seizure onset, type of seizure, time period between the onset of the first seizure and start of treatment, number of seizures in the time period between the start of AED therapy and the last seizure, number of AEDs before remission, time period between the start of AED therapy and the last seizure, time period between the last seizure and withdrawal of AED treatment (seizure-free period, timing of AED withdrawal), time period between the start of AED withdrawal and total discontinuation(speed of withdrawal), EEG registered at the time of diagnosis, before AED withdrawal, during and after AED withdrawal, and the condition of recurrence, data analysed by multi-variate step-wise Cox regression model analysis. Results A total of 16(12.8%) children relapsed in a total number of 125 children with idiopathic epilepsy we collected; date evaluated by multi-variable analysis showed that the children suffering from seizure type of focal seizure, starting withdrawal after a seizure-free period of less than 3 years and with abnormal post-withdrawal EEG recording was associated with a higher risk of seizure recurrence. Conclusions Children with idiopathic epilepsy have a low risk of recurrence after AED withdrawal. Those who suffer from seizure type of focal seizure, start withdrawal after a seizure-free period of less than 3 years and with abnormal post-withdrawal EEG recording are associated with a higher risk of seizure recurrence.

Citation： FUXiafei, HANYunli. Analysis of the factors of recurrence after discontinuation of antiepileptic drugs in the first year in children with idiopathic epilepsy. Journal of Epilepsy, 2016, 2(1): 24-29. doi: 10.7507/2096-0247.20160005 Copy

1.	EH Reynolds. ILAE/IBE/WHO Global Campaign "out of the shadows": global and regional developments. Epilepsia, 2001, 42(8): 1094-1100.
2.	常琳.中国癫痫流行病学调查研究进展.国际神经病学神经外科学杂志, 2012, 39(2): 161-164.
3.	Specchio LM, Beghi E. Should antiepileptic drugs be withdrawn in seizure-free patients?. CNS Drugs, 2004, 18(4): 201-212.
4.	Verrotti A, D Egidio C, Agostinelli S, et al. Antiepileptic drug withdrawal in childhood epilepsy: what are the risk factors associated with seizure relapse?. Elsevier, 2012, 16(6): 599-604.
5.	Dooley J, Gordon K, Camfield P, et al. Discontinuation of anticonvulsant therapy in children free of seizures for 1 year: a prospective study. Neurology, 1996, 46(4): 969-974.
6.	Tinuper P, Avoni P, Riva R, et al. The Prognostic value of the electroencephalogram in antiepileptic drug withdrawal in partial epilepsies. Neurology, 1996, 47(1): 76-78.
7.	Hawash KY, Rosman NP. Do partial seizures predict an increased risk of seizure recurrence after antiepilepsy drugs are withdrawn?. Journal of Child Neurology, 2003, 18(5): 331-337.
8.	Altunbasak S, Artar O, Burgut R, et al. Relapse risk analysis after drug withdrawal in epileptic children with uncomplicated seizures. Seizure, 1999, 8(3): 384-389.
9.	Olmez A, Arslan U, Turanli G, et al. Risk of recurrence after drug withdrawal in childhood epilepsy. Seizure, 2009, 18(4): 251-256.
10.	Camfield P, Camfield C. The frequency of intractable seizures after stopping AEDs in seizure-free children with epilepsy. Neurology, 2005, 64(20): 973-975.
11.	Shinnar S, Vining EP, Mellits ED, et al. Discontinuing antiepileptic medication in children with epilepsy after two years without seizures: a prospective study. N Engl J Med, 1985, 313(8): 976-980.
12.	Emerson R, D Souza BJ, Vining EP, et al. Stopping medication in children with epilepsy: predictors of outcome. N Engl J Med, 1981, 304(7): 1125-1129.
13.	Tennison M, Greenwood R, Lewis D, et al. Discontinuing antiepileptic drugs in children with epilepsy. N Engl J Med, 1994, 330(20): 1407-1410.
14.	Mastropaolo C, Tondi M, Carboni F, et al. Prognosis after therapy discontinuation in children with epilepsy. Eur Neurol, 1992, 32(9): 141-145.
15.	Matricardi M, Brinciotti M, Benedetti P. Outcome after discontinuation of antiepileptic drug therapy in children with epilepsy. Epilepsia, 1989, 30(5): 582-589.
16.	Ramos-Lizana J, Aguirre-Rodríguez J, Aguilera-Lopez P, et al. Recurrence risk after withdrawal of antiepileptic drugs in children with epilepsy: a prospective study. Eur J Paediatr Neurol, 2010, 14(2): 116-124.
17.	Juul-Jensen P. Frequency of recurrence after discontinuance of anticonvulsant therapy in patients with epileptic seizures: a new follow-up study after 5 years. Epilepsia, 1968, 9(1): 11-16.
18.	Sillanpaa M, Schmidt D. Prognosis of seizure recurrence after stopping antiepileptic drugs in seizure-free patients: a long-term population-based study of childhood-onset epilepsy. Epilepsy & Behavior, 2006, 8(4): 713-719.
19.	Schmidt D, Loscher W. Uncontrolled epilepsy following discontinuation of antiepileptic drugs in seizure-free patients: a review of current clinical experience. Acta Neurologica Scandinavica, 2005, 111(5): 291-300.
20.	Arts WF, Visser LH, Loonen MC, et al. Follow-up of 146 children with epilepsy after withdrawal of antiepileptic therapy. Epilepsia, 1988, 29(50): 244-250.
21.	Shinnar S, Berg AT, Moshe SL. Discontinuing antiepileptic drugs in children with epilepsy: A prospective study. Annals of Neurology, 1994, 35(5): 534-545.
22.	Overweg J, Binnie CD, Rowan AJ, et al. Clinical and EEG prediction of seizure recurrence following antiepileptic drug withdrawal. Epilepsy Res, 1987, 1(5): 272-283.
23.	Medical Research Council Antiepileptic Drug Withdrawal Study Group. Randomised study of antiepileptic drug withdrawal in patients in remission. Lancet, 1991, 337(8751): 1175-1180.
24.	Donati F, Hassink RI, Vassella F, et al. Factors predicting the risk of relapse after antiepileptic drug discontinuation in children with partial seizures. Eur J Pediatr, 1995, 154(Suppl 1): 44-47.
25.	Strozzi I, Nolan SJ, Sperling MR, et al. Early versus late antiepileptic drug withdrawal for people with epilepsy in remission. Cochrane Database Syst Rev, 2015, 132(2): CD001902.
26.	Cardoso TA, Cendes F, Guerreiro CA. Is low antiepileptic drug does effective in long-term seizure-free patients. Arq Neuropsiquiatr, 2003, 61(3A): 566-573.
27.	苏凌璎, 狄晴, 余年, 等.不同撤药时机对癫痫患者复发的影响.中华神经医学杂志, 2012, 11(10): 982-985.
28.	Serra JG, Montenegro MA, Guerreiro MM. Antiepileptic drug withdrawal in childhood: dose the duration of tapering off matter for seizure recurrence. J Child Neurol, 2005, 20(7): 624-626.
29.	Ranganathan LN, Ramaratnam S. Rapid versus slow withdrawal of antiepileptic drugs. Cochrane Datebase Syst Rev, 2006, 19(2): CD005003.
30.	王凌玲, 苏凌璎, 狄晴, 等.不同撤药速度对癫痫患者复发的影响.中国神经精神疾病杂志, 2012, 38(12): 716-719.
31.	李维, 周东.癫痫撤药相关问题.中国神经精神疾病杂志, 2013, 39(6): 382-384.
32.	Verrotti A, Morresi S, Cutarella R, et al. Predictive value of EEG monitoring during drug withdrawal in children with cryptogenic partial epilepsy. Neurophysiol Clin, 2000, 30(4): 240-245.

1. EH Reynolds. ILAE/IBE/WHO Global Campaign "out of the shadows": global and regional developments. Epilepsia, 2001, 42(8): 1094-1100.
2. 常琳.中国癫痫流行病学调查研究进展.国际神经病学神经外科学杂志, 2012, 39(2): 161-164.
3. Specchio LM, Beghi E. Should antiepileptic drugs be withdrawn in seizure-free patients?. CNS Drugs, 2004, 18(4): 201-212.
4. Verrotti A, D Egidio C, Agostinelli S, et al. Antiepileptic drug withdrawal in childhood epilepsy: what are the risk factors associated with seizure relapse?. Elsevier, 2012, 16(6): 599-604.
5. Dooley J, Gordon K, Camfield P, et al. Discontinuation of anticonvulsant therapy in children free of seizures for 1 year: a prospective study. Neurology, 1996, 46(4): 969-974.
6. Tinuper P, Avoni P, Riva R, et al. The Prognostic value of the electroencephalogram in antiepileptic drug withdrawal in partial epilepsies. Neurology, 1996, 47(1): 76-78.
7. Hawash KY, Rosman NP. Do partial seizures predict an increased risk of seizure recurrence after antiepilepsy drugs are withdrawn?. Journal of Child Neurology, 2003, 18(5): 331-337.
8. Altunbasak S, Artar O, Burgut R, et al. Relapse risk analysis after drug withdrawal in epileptic children with uncomplicated seizures. Seizure, 1999, 8(3): 384-389.
9. Olmez A, Arslan U, Turanli G, et al. Risk of recurrence after drug withdrawal in childhood epilepsy. Seizure, 2009, 18(4): 251-256.
10. Camfield P, Camfield C. The frequency of intractable seizures after stopping AEDs in seizure-free children with epilepsy. Neurology, 2005, 64(20): 973-975.
11. Shinnar S, Vining EP, Mellits ED, et al. Discontinuing antiepileptic medication in children with epilepsy after two years without seizures: a prospective study. N Engl J Med, 1985, 313(8): 976-980.
12. Emerson R, D Souza BJ, Vining EP, et al. Stopping medication in children with epilepsy: predictors of outcome. N Engl J Med, 1981, 304(7): 1125-1129.
13. Tennison M, Greenwood R, Lewis D, et al. Discontinuing antiepileptic drugs in children with epilepsy. N Engl J Med, 1994, 330(20): 1407-1410.
14. Mastropaolo C, Tondi M, Carboni F, et al. Prognosis after therapy discontinuation in children with epilepsy. Eur Neurol, 1992, 32(9): 141-145.
15. Matricardi M, Brinciotti M, Benedetti P. Outcome after discontinuation of antiepileptic drug therapy in children with epilepsy. Epilepsia, 1989, 30(5): 582-589.
16. Ramos-Lizana J, Aguirre-Rodríguez J, Aguilera-Lopez P, et al. Recurrence risk after withdrawal of antiepileptic drugs in children with epilepsy: a prospective study. Eur J Paediatr Neurol, 2010, 14(2): 116-124.
17. Juul-Jensen P. Frequency of recurrence after discontinuance of anticonvulsant therapy in patients with epileptic seizures: a new follow-up study after 5 years. Epilepsia, 1968, 9(1): 11-16.
18. Sillanpaa M, Schmidt D. Prognosis of seizure recurrence after stopping antiepileptic drugs in seizure-free patients: a long-term population-based study of childhood-onset epilepsy. Epilepsy & Behavior, 2006, 8(4): 713-719.
19. Schmidt D, Loscher W. Uncontrolled epilepsy following discontinuation of antiepileptic drugs in seizure-free patients: a review of current clinical experience. Acta Neurologica Scandinavica, 2005, 111(5): 291-300.
20. Arts WF, Visser LH, Loonen MC, et al. Follow-up of 146 children with epilepsy after withdrawal of antiepileptic therapy. Epilepsia, 1988, 29(50): 244-250.
21. Shinnar S, Berg AT, Moshe SL. Discontinuing antiepileptic drugs in children with epilepsy: A prospective study. Annals of Neurology, 1994, 35(5): 534-545.
22. Overweg J, Binnie CD, Rowan AJ, et al. Clinical and EEG prediction of seizure recurrence following antiepileptic drug withdrawal. Epilepsy Res, 1987, 1(5): 272-283.
23. Medical Research Council Antiepileptic Drug Withdrawal Study Group. Randomised study of antiepileptic drug withdrawal in patients in remission. Lancet, 1991, 337(8751): 1175-1180.
24. Donati F, Hassink RI, Vassella F, et al. Factors predicting the risk of relapse after antiepileptic drug discontinuation in children with partial seizures. Eur J Pediatr, 1995, 154(Suppl 1): 44-47.
25. Strozzi I, Nolan SJ, Sperling MR, et al. Early versus late antiepileptic drug withdrawal for people with epilepsy in remission. Cochrane Database Syst Rev, 2015, 132(2): CD001902.
26. Cardoso TA, Cendes F, Guerreiro CA. Is low antiepileptic drug does effective in long-term seizure-free patients. Arq Neuropsiquiatr, 2003, 61(3A): 566-573.
27. 苏凌璎, 狄晴, 余年, 等.不同撤药时机对癫痫患者复发的影响.中华神经医学杂志, 2012, 11(10): 982-985.
28. Serra JG, Montenegro MA, Guerreiro MM. Antiepileptic drug withdrawal in childhood: dose the duration of tapering off matter for seizure recurrence. J Child Neurol, 2005, 20(7): 624-626.
29. Ranganathan LN, Ramaratnam S. Rapid versus slow withdrawal of antiepileptic drugs. Cochrane Datebase Syst Rev, 2006, 19(2): CD005003.
30. 王凌玲, 苏凌璎, 狄晴, 等.不同撤药速度对癫痫患者复发的影响.中国神经精神疾病杂志, 2012, 38(12): 716-719.
31. 李维, 周东.癫痫撤药相关问题.中国神经精神疾病杂志, 2013, 39(6): 382-384.
32. Verrotti A, Morresi S, Cutarella R, et al. Predictive value of EEG monitoring during drug withdrawal in children with cryptogenic partial epilepsy. Neurophysiol Clin, 2000, 30(4): 240-245.

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