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Published on: May 16, 2019
First, do no harm: the risks of overtreating children with epilepsy
Eunice Chuang1, Marilisa M Guerreiro, Sara Y Tsuchie
1Department of Neurology, State University of Campinas, 13083-970 Campinas, SP, Brazil.
Tapering antiepileptic drugs (AEDs) in children with refractory epilepsy can improve seizure control and reduce adverse events. This study found that withdrawing at least one AED led to seizure freedom or improvement in over 47% of participants.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
- Epileptology
Background:
- Overtreatment with antiepileptic drugs (AEDs) is a significant concern in pediatric epilepsy, contributing to patient morbidity.
- Despite concerns, overtreatment remains prevalent in managing childhood epilepsy.
Purpose of the Study:
- To assess the efficacy of antiepileptic drug (AED) withdrawal in improving seizure control for children with refractory epilepsy on polytherapy.
- To evaluate if reducing the number of AEDs in children with refractory epilepsy leads to better seizure outcomes.
Main Methods:
- A prospective study design was employed.
- Children with refractory epilepsy on at least two AEDs were enrolled.
- Participants underwent slow tapering of one or more AEDs, with adjustments to remaining dosages permitted but no new AEDs introduced.
Main Results:
- Fifteen pediatric patients (ages 3-18) were evaluated.
- Following AED withdrawal, 13.5% achieved seizure freedom, and 33.5% experienced >50% seizure improvement.
- 80% of patients reported improvement in adverse events, with seizure frequency worsening in 20%.
Conclusions:
- Withdrawal of at least one AED is a viable therapeutic strategy for select pediatric patients with refractory epilepsy.
- Reducing AED burden in children with refractory epilepsy can lead to improved seizure control and reduced side effects.
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