Document Type: Original Article

Authors

1 Department of Pediatric Neurology, Ankara City Hospital, Ankara, Turkey

2 Department of Pediatric Neurology, Ondokuz Mayis University, Samsun, Turkey

3 Department of Pediatric Neurology, University of Health Sciences, Dr. Sami Ulus Research and Training Hospital, Ankara, Turkey

4 Department of Pediatric Neurology, WM Medical Park Pendik Hospital, Istanbul, Turkey

Abstract

Background: The aim of this study was to identify the demographic-clinical variables affecting idiopathic epilepsy (IE) [called genetic generalized epilepsy (GGE)] recurrence and determine cut-off values that can be used in pediatric neurology practice for children with IE/GGE.
Methods: A total of 250 children and adolescents with IE/GGE were included and retrospectively evaluated. The patients’ hospital records were examined in order to identify possible electro-clinical features affecting epilepsy recurrence.
Results: The overall rate of recurrence in the patients was 46%; the age at onset of seizures in recurrence group was lower (P = 0.040) and the age at last seizure was higher in the recurrence group (P < 0.001) than that in the non-recurrence group. Other factors found to be related to recurrence were the shorter duration of the seizure-free period (P = 0.030), shorter interval between the last seizure and antiepileptic drug (AED) withdrawal (P = 0.003), shorter duration of AED withdrawal (P = 0.005), and the existence of abnormalities on sleep electroencephalogram (EEG) during AED withdrawal (P = 0.010) and at the 6th month of withdrawal (P < 0.001). According to receiver operating characteristic (ROC) analysis, the risk of IE recurrence was higher in children who were younger than 3.6 years old (sensitivity: 65.6%, specificity: 62.7%), children with a seizure-free period that was shorter than 35.5 months (sensitivity: 89.6%, specificity: 32.8%), and children whose drug withdrawal period was shorter than 4.5 months (sensitivity: 56.3%, specificity: 71.6%).
Conclusion: This study defined some electro-clinical factors that could guide clinicians when deciding to withdraw AEDs with regard to recurrence risk after evaluating a homogenous population of children with a diagnosis of IE/GGE.

Keywords

  1. Proposal for revised classification of epilepsies and epileptic syndromes. Commission on classification and terminology of the international league against epilepsy. Epilepsia 1989; 30(4): 389-99.
  2. Bouma PA, Peters AC, Arts RJ, Stijnen T, Van Rossum J. Discontinuation of antiepileptic therapy: A prospective study in children. J Neurol Neurosurg Psychiatry 1987; 50(12): 1579-83.
  3. Gherpelli JL, Kok F, dal Forno S., Elkis LC, Lefevre BH, Diament AJ. Discontinuing medication in epileptic children: A study of risk factors related to recurrence. Epilepsia 1992; 33(4): 681-6.
  4. Verrotti A, Morresi S, Basciani F, Cutarella R, Morgese G, Chiarelli F. Discontinuation of anticonvulsant therapy in children with partial epilepsy. Neurology 2000; 55(9): 1393-5.
  5. Arts WF, Visser LH, Loonen MC, Tjiam AT, Stroink H, Stuurman PM, et al. Follow-up of 146 children with epilepsy after withdrawal of antiepileptic therapy. Epilepsia 1988; 29(3): 244-50.
  6. Matricardi M, Brinciotti M, Benedetti P. Outcome after discontinuation of antiepileptic drug therapy in children with epilepsy. Epilepsia 1989; 30(5): 582-9.
  7. Emerson R, D'Souza BJ, Vining EP, Holden KR, Mellits ED, Freeman JM. Stopping medication in children with epilepsy: Predictors of outcome. N Engl J Med 1981; 304(19): 1125-9.
  8. Murakami M, Konishi T, Naganuma Y, Hongou K, Yamatani M. Withdrawal of antiepileptic drug treatment in childhood epilepsy: Factors related to age. J Neurol Neurosurg Psychiatry 1995; 59(5): 477-81.
  9. Lamberink HJ, Otte WM, Geerts AT, Pavlovic M, Ramos-Lizana J, Marson AG, et al. Individualised prediction model of seizure recurrence and long-term outcomes after withdrawal of antiepileptic drugs in seizure-free patients: A systematic review and individual participant data meta-analysis. Lancet Neurol 2017; 16(7): 523-31.
  10. Andersson T, Braathen G, Persson A, Theorell K. A comparison between one and three years of treatment in uncomplicated childhood epilepsy: A prospective study. II. The EEG as predictor of outcome after withdrawal of treatment. Epilepsia 1997; 38(2): 225-32.
  11. Ramos-Lizana J, Aguirre-Rodriguez J, Aguilera-Lopez P, Cassinello-Garcia E. Recurrence risk after withdrawal of antiepileptic drugs in children with epilepsy: A prospective study. Eur J Paediatr Neurol 2010; 14(2): 116-24.
  12. Peters AC, Brouwer OF, Geerts AT, Arts WF, Stroink H, van Donselaar CA. Randomized prospective study of early discontinuation of antiepileptic drugs in children with epilepsy. Neurology 1998; 50(3): 724-30.
  13. Braathen G, Melander H. Early discontinuation of treatment in children with uncomplicated epilepsy: A prospective study with a model for prediction of outcome. Epilepsia 1997; 38(5): 561-9.
  14. Serra JG, Montenegro MA, Guerreiro MM. Antiepileptic drug withdrawal in childhood: Does the duration of tapering off matter for seizure recurrence? J Child Neurol 2005; 20(7): 624-6.
  15. Arts WF, Brouwer OF, Peters AC, Stroink H, Peeters EA, Schmitz PI, et al. Course and prognosis of childhood epilepsy: 5-year follow-up of the Dutch study of epilepsy in childhood. Brain 2004; 127(Pt 8): 1774-84.
  16. Altunbasak S, Artar O, Burgut R, Yildiztas D. Relapse risk analysis after drug withdrawal in epileptic children with uncomplicated seizures. Seizure 1999; 8(7): 384-9.
  17. Olmez A, Arslan U, Turanli G, Aysun S. Risk of recurrence after drug withdrawal in childhood epilepsy. Seizure 2009; 18(4): 251-6.
  18. Sillanpaa M, Jalava M, Kaleva O, Shinnar S. Long-term prognosis of seizures with onset in childhood. N Engl J Med 1998; 338(24): 1715-22.
  19. Shinnar S, Vining EP, Mellits ED, D'Souza BJ, Holden K, Baumgardner RA, et al. Discontinuing antiepileptic medication in children with epilepsy after two years without seizures. A prospective study. N Engl J Med 1985; 313(16): 976-80.
  20. Hawash KY, Rosman NP. Do partial seizures predict an increased risk of seizure recurrence after antiepilepsy drugs are withdrawn? J Child Neurol 2003; 18(5): 331-7.