title: Randomized prospective study of early discontinuation of antiepileptic drugs in children with epilepsy.
abstract: We studied recurrence rate, risk factors for recurrence, and outcome after recurrence in children after early withdrawal of antiepileptic drugs (AEDs). One hundred sixty-one children with newly diagnosed epilepsy who had become seizure free within 2 months after starting treatment and remained so for 6 months were randomly assigned to immediate withdrawal of AEDs (n = 78) or continuation of treatment for another 6 months followed by withdrawal (n = 83). The probability of remaining seizure free at 24 months after randomization was 51% (95% CI, 40 to 62) in Group A and 52% (41 to 63) in Group B. Significant predictive factors for relapse were partial epilepsy, seizure onset at 12 years or older, defined etiology, and epileptiform EEG before randomization. At the end of follow-up (median, 41.9 months), 129 children (80.6%) had a terminal remission of at least 1 year, 88 without AEDs and 41 with AEDs. No significant difference in outcome was found between Groups A and B. In children with epilepsy and an early response to therapy, AED withdrawal after 6 or 12 months of treatment leads to seizure recurrence in approximately half of all patients regardless of the duration of therapy. More than 60% of those with one or more recurrences reach a terminal remission of at least 1 year after long-term follow-up with or without AEDs.
authors.affiliation: Department of Neurology, Leiden University Medical Centre, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Peters
authors.forename: O F
authors.initials: OF
authors.lastname: Brouwer
authors.forename: A T
authors.initials: AT
authors.lastname: Geerts
authors.forename: W F
authors.initials: WF
authors.lastname: Arts
authors.forename: H
authors.initials: H
authors.lastname: Stroink
authors.forename: C A
authors.initials: CA
authors.lastname: van Donselaar
mesh_terms: D000293:Adolescent; D000375:Aging / Q000502:physiology; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015999:Multivariate Analysis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000927:Anticonvulsants