title: First, do no harm: the risks of overtreating children with epilepsy.
abstract: BACKGROUND
  Although overtreatment with antiepileptic drugs contributes to the morbidity associated with epilepsy, many children still are overtreated.
  
  
  OBJECTIVE
  To evaluate if the withdrawal of at least one antiepileptic drug (AED) in children with refractory epilepsy using polytherapy enable a better seizure control.
  
  
  METHODS
  This was a prospective study. Children with refractory epilepsy using at least two AEDs were included. Once the patient, or guardian, agreed to participate in the study, one or more AED were slowly tapered off. The remaining AEDs dosages could be adjusted as needed, but a new AED could not be introduced.
  
  
  RESULTS
  Fifteen patients were evaluated, three girls; ages ranging from 3 to 18 (mean=8.7 years). After at least one AED withdrawal, two (13.5%) patients became seizure free, seizures improved >50% in 5 (33.5%) patients, did not change in 5 (33.5%), and seizure frequency became worse in 3 (20%). Adverse events improved in 12 patients (80%).
  
  
  CONCLUSIONS
  The withdrawal of at least one AED is a valuable option in the treatment of selected children with refractory epilepsy.
authors.affiliation: Department of Neurology, State University of Campinas, 13083-970 Campinas, SP, Brazil.
authors.forename: Eunice
authors.initials: E
authors.lastname: Chuang
authors.forename: Marilisa M
authors.initials: MM
authors.lastname: Guerreiro
authors.forename: Sara Y
authors.initials: SY
authors.lastname: Tsuchie
authors.forename: Angelica
authors.initials: A
authors.lastname: Santucci
authors.forename: Carlos A M
authors.initials: CA
authors.lastname: Guerreiro
authors.forename: Maria Augusta
authors.initials: MA
authors.lastname: Montenegro
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000927:Anticonvulsants