Objective: This retrospective study aimed to precisely characterize the factors necessitating antiseizure medication (ASM) discontinuation in pediatric epilepsy patients and to delineate drug-specific adverse event patterns based on monotherapy and polytherapy regimens.
Methods: We retrospectively analyzed data from patients under 18 years of age, followed at a single Pediatric Neurology Clinic between January 2015 and September 2024. Discontinuation was defined as the cessation of a medication due to inadequate efficacy or intolerable adverse effects. Patient demographics, epilepsy classification, ASM regimen, treatment duration, and detailed reasons for discontinuation were collected for analysis.
Results: Out of 4578 pediatric epilepsy patients screened, ASM discontinuation was recorded in 169 cases (4 %). The discontinuation rate was higher in polytherapy (68/1373, 5 %) than in monotherapy (101/3205, 3 %). The most frequent compelling reasons for cessation were seizure persistence or worsening (48/169, 28 %) and psychiatric adverse effects (40/169, 24 %). Levetiracetam was overwhelmingly associated with psychiatric complaints (25/34, 74 %), while carbamazepine demonstrated a powerful correlation with the emergence of continuous spikes and waves during sleep (CSWS) like sleep-activated epileptiform EEG pattern (28/42, 67 %), leading to its withdrawal. The mean time to discontinuation was 8 ± 6 months.
Conclusion: Our real-world data confirms that persistent seizures and drug-induced psychiatric adverse effects are the dominant causes of ASM discontinuation in children. The particular correlations between levetiracetam and psychiatric issues, and carbamazepine and CSWS-like sleep-activated EEG pattern, highlight the critical necessity for highly individualized ASM selection and close clinical and electroencephalographic monitoring in pediatric practice.
Keywords: Adverse effects; Antiseizure medications; Drug discontinuation; Pediatric epilepsy.
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