Seizure recurrence and risk factors after withdrawal of chronic antiepileptic therapy in children

Abstract

The aim of this study was to identify the risk factors for seizure recurrence after withdrawal of chronic antiepileptic therapy in 226 children: 136 with partial epilepsies and 90 with generalized epilepsies. The influence on prognosis of the different variables was assessed retrospectively with univariate and multivariate analysis. With a mean observation period of 5.85+/-3.87 years, seizure recurrence occurred in 24.3% of all patients with partial and generalized epilepsies. In children with partial epilepsies, the following factors were found to significantly increase relapse risk after treatment withdrawal: neurological abnormalities; interval between seizures less than 1 month at onset of illness; the use of VPA in treating seizures; start of withdrawal after 6 years of age; frontal paroxysmal activity; and abnormal EEG before drug withdrawal. In children with generalized epilepsies the risk factors were found to be: abnormal neonatal period; first seizure after 10 years of age; mean duration of seizures greater than 1 minute; poor school progress and generalized spike-waves in EEG. The factors associated with the risk of recurrence in children with generalized epilepsy appear to differ from to those related to partial epilepsies, in which seizure treatment with VPA was associated with an increased recurrence risk after the withdrawal of antiepileptic drugs.