Discontinuing anti-epileptic medication(s) in epileptic children: 18 versus 24 months
A Gebremariam1, W Mengesha, F Enqusilassie
1Department of Paediatrics and Child Health, Faculty of Medicine, Addis Ababa University, Ethiopia.
Insights
Stopping anti-convulsant medication after 18 months of seizure freedom in children did not increase seizure recurrence compared to continuing medication for 24 months. EEG abnormalities at discontinuation were linked to higher recurrence risk.
Area of Science:
- Pediatric Neurology
- Clinical Epilepsy Research
Background:
- Epilepsy management in children often involves long-term anti-convulsant medication.
- Determining optimal duration for anti-convulsant therapy cessation is crucial for minimizing relapse risk and medication side effects.
Purpose of the Study:
- To compare seizure recurrence rates in children with epilepsy after discontinuing anti-convulsant medication at 18 months versus 24 months of seizure freedom.
- To identify risk factors associated with seizure recurrence upon anti-convulsant medication withdrawal.
Main Methods:
- Prospective study of 80 children with epilepsy, seizure-free for at least 18 months.
- Random assignment into two groups: 18-month seizure-free group (discontinuation) and 24-month seizure-free group (continued medication).
- Follow-up to monitor seizure recurrence; statistical analysis using log-rank test and risk factor assessment.
Main Results:
- Seizure recurrence rates were 29% in the 18-month group and 36% in the 24-month group, with no statistically significant difference (p > 0.50).
- EEG abnormality at the time of anti-convulsant medication discontinuation was significantly associated with an increased risk of seizure recurrence (p < 0.001).
Conclusions:
- Discontinuing anti-convulsant medication after 18 months of seizure freedom appears safe in pediatric epilepsy, with similar recurrence rates to continuing for 24 months.
- Electroencephalogram (EEG) findings at medication withdrawal are a critical predictor of seizure recurrence risk in children with epilepsy.
Abstract:
For a period of slightly over 4 years, 80 children who had been seizure-free for at least 18 months while on anti-convulsant medication were prospectively collected. These 80 children were randomly assigned to either the 18-months seizure-free group (n = 41) or to the group where anti-convulsant medications were continued for another 6 months before they were gradually tapered off and stopped, i.e. the 24-months seizure-free group (n = 39). Twelve (29%) of the 41 children who had been seizure-free for 18 months and 14 (36%) of the 39 children who had been seizure-free for 24 months had seizure recurrence during the follow-up period. Log-rank test of the recurrence experience of the two groups of patients showed no statistically significant difference between the groups (p > 0.50). Similarly, when both groups were combined and other risk variables likely to influence the rate of seizure recurrence were tested, only EEG abnormality at discontinuation of anti-convulsant medication had a significant association with the risk of seizure recurrence (p < 0.001).
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