Aims: We investigated seizure-relapse risk following antiseizure medication (ASM) withdrawal in children with focal epilepsy (FE) who were leading to seizure remission by ASM monotherapy without drug replacement.
Methods: Participants were treated at our hospital between 1 July 1999 and 30 June 2015. Children showing abnormalities on brain MRI and self-limited FE were excluded. All children discontinued ASMs after more than 2 years of a seizure-free state. Associations between seizure relapse within 2 years following ASM withdrawal and age at onset, seizure-free interval before ASM withdrawal, duration of tapering, presence of interictal epileptiform discharges (IEDs) on electroencephalogram (EEG), and type of ASM used were evaluated.
Results: Participants comprised 128 FE children. Twelve children (9.7 %) experienced seizure relapse. Ages at both onset and ASM withdrawal were significantly higher in the relapse group than in the non-relapse group (p < 0.0001 and p = 0.0003, respectively). Seizure-free interval before ASM withdrawal was significantly shorter in the relapse (mean, 2.6 years) than in the non-relapse group (3.6 years; p < 0.0001). Duration of tapering was significantly shorter in the relapse (mean, 5.3 months) than in the non-relapse group (9.2 months; p < 0.0001). Presence of IEDs was significantly more frequent in the relapse than in the non-relapse group (p = 0.03). Seizure relapse tended to be less frequent with levetiracetam treatment than with carbamazepine, but the difference was not significant (p = 0.067).
Conclusions: Among FE children who achieve a seizure-free state on ASMs for more than 3 years, clinicians should recommend withdrawal of ASM using a slow tapering schedules lasting more than 6 months.
Keywords: Antiseizure medication; Children; Duration; Seizure relapse; Seizure-free state; Withdrawal.
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