Seizure remission and antiepileptic drug discontinuation in children with tuberous sclerosis complex.
BACKGROUND
Epilepsy is a common neurologic complication of tuberous sclerosis complex (TSC) and it is often refractory to treatment. Therefore, treating physicians are often reluctant to discontinue antiepileptic drugs (AEDs) in individuals with TSC who have attained seizure remission. To our knowledge, seizure remission and AED discontinuation in children with TSC has not been studied.


OBJECTIVE
To characterize seizure remission and AED discontinuation in children with TSC.


METHODS
Retrospective medical record and neuroimaging analysis of 15 children with TSC and epilepsy who had seizure remission, with a subsequent trial of discontinuation of AED treatment.


RESULTS
The seizure remission rate for the group of patients with TSC and epilepsy was 14.2%. From the group of 15 patients who had a remission, the absolute relapse rate was 26.7% after a mean follow-up of 5 years 7 months. Patients with sustained remission were more likely to have normal intelligence and only a few cortical or subcortical lesions on neuroimaging.


CONCLUSIONS
The proportion of children with TSC and epilepsy who achieve seizure remission is small. Nevertheless, some do attain seizure remission, and AEDs may be successfully discontinued. Mild cerebral involvement is a general clinical marker for seizure remission. The relapse rate in those who have undergone a trial of discontinuation of AED therapy is comparable with the rate in the general pediatric population with epilepsy.
Sparagana
Steven P
SP
Department of Child Neurology, Texas Scottish Rite Hospital for Children, Dallas 75219, USA. steven.sparagana@tsrh.org
Delgado
Mauricio R
MR
Batchelor
Lori L
LL
Roach
E Steve
ES
D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012074:Remission Induction; D012189:Retrospective Studies; D014402:Tuberous Sclerosis / Q000150:complications*
D000927:Anticonvulsants