SEATTLE—Children who achieve seizure freedom after taking antiepileptic drugs (AEDs) can safely withdraw without high risk of intractable epilepsy, according to research presented at the 62nd Annual Meeting of the American Epilepsy Society.
Katherine Nickels, MD, an Instructor of Neurology at the Mayo Clinic in Rochester, Minnesota, and colleagues observed the records of all children in Olmsted County, Minnesota, who were diagnosed with new-onset epilepsy between 1990 and 2000. All children (ages one month to 16 years) were followed up for at least five years after the first afebrile seizure to determine the proportion of seizure recurrence and those who developed intractable epilepsy. Intractable epilepsy was defined as having at least one seizure every three months during the last year of follow-up and efficacy failure of at least two AEDs at the maximum-tolerated doses.
Of those treated, 55 children (36%) achieved seizure freedom and withdrew from their AEDs (mean duration of seizure-free treatment was 2.3 years). After a mean follow-up of eight years, 20 participants experienced at least one seizure recurrence. Eight children (40%) experienced seizure recurrence within six months, and 11 children (55%) had a seizure recurrence within the first year. Four (20%) had another seizure after more than five years.
In addition, the investigators found that 15 of those who experienced seizure recurrence had restarted their AED medication. Four children remained off medication and had rare or no recurrence. One child died of a seizure-related death shortly after restarting medication. Those who restarted medication were followed for an average of 5.7 years. “Of the 15 patients who then restarted their antiseizure medications, 53% became seizure-free quickly, within one year,” Dr. Nickels stated. “Another 15% became seizure-free after two years, 33% were never seizure-free, and 20% of that 15 were intractable.
“Only 20% proved intractable, which is similar to the risk of intractable epilepsy at time of initial diagnosis of epilepsy in children,” Dr. Nickels concluded. “Children who achieve seizure freedom on AEDs can be considered for withdrawal without high risk of intractable epilepsy.
—Laura Sassano