A Follow-Up Study after Discontinuation of Antiepileptic Drug Therapy in Children with Well-Controlled Epilepsy: The Factors that Influence Recurrence.
- Author:
Sa Jun CHUNG
1
;
Hye Jeon CHUNG
;
Young Mi CHOI
;
Eu Hyun CHO
Author Information
1. Department of Pediatrics, College of Medicine, Kyung-Hee University, Seoul, Korea. sajchung@khmc.or.kr
- Publication Type:Original Article
- Keywords:
Epilepsy;
Relapse;
Antiepileptic drugs;
Seizure-free period;
Risk factors
- MeSH:
Age of Onset;
Anticonvulsants;
Child*;
Drug Therapy*;
Epilepsy*;
Follow-Up Studies*;
Humans;
Multivariate Analysis;
Neurologic Manifestations;
Parents;
Proportional Hazards Models;
Recurrence*;
Risk Factors
- From:Journal of the Korean Pediatric Society
2002;45(12):1559-1570
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: There has been no exact answer to the question of when to discontinue antiepileptic drugs(AEDs) in children with well-controlled epilepsy for a long period. This study is about the risk factors of relapse after withdrawal of AEDs in seizure(Sz)-free patients to show a guideline for discontinuation of AEDs. METHODS: One hundred and sixty-nine children were diagnosed as epileptic at the Pediatric Dept.of Kyung-Hee Univ. between 1993 to 1998, in whom AEDs had been withdrawn after at least two years of Sz-free period. Univariate analysis using Kaplan-Meier survival analysis and multivariate analysis using Cox-proportional hazard model were performed for sixteen risk factors. RESULTS: Forty-nine of the 169 patients(28.9%) had recurrence of Szs. The mean follow-up after withdrawal of AEDs was 4.1 years, mean treatment period was 4.1 years, and the mean Sz-free period was 3.3 years. Factors associated with an increased risk of relapse were young age at onset, symptomatic Sz, Sz type in West and Lennox-Gastaut syndrome, neurologic deficit, longer Sz-controlling period, shorter total treatment period, number of AEDs used(more than one drug), age at withdrawal of AEDs, and Sz-free period less than two years in univariate analysis using Kaplan-Meier mothod. From multivariate analysis, the factors indicating a significantly higher relapse risk were pre-treatment period after first Sz attack, Sz-controlling period, Sz-free period, number of AEDs used, neurologic abnormalities. CONCLUSIONS: For epileptic children who were Sz-free for more than two years, and were more than six-years-old, the discontinuation of AEDs should be considered positively, according to age of onset, Sz type, age at withdrawal of AEDs, total treatment period, Sz-controlling period, number of AEDs used, etiology, neurologic deficit, and the wishes of the patients and the their parents.
