Determination of recurrence rate after remission in the epilepsy patients whose antiepileptic therapy has been discontinued and evaluation of epidemiological and clinical features of these patients

Purpose: More than 10 million children worldwide have some form of epilepsy. Long- term adverse effects of antiepileptic drugs (AEDs) are well-known, particularly in children. After a reasonable seizure-free period, discontinuation of antiepileptic drugs (AED) is usually decided in epileptic patients despite the risk of seizure recurrence. In children, risk of recurrence after discontinuation of AED is generally 20-40%; however, there is still no general agreement on the criteria to predict safe discontinuation. This study was designed to evaluate retrospectively the recurrence rate of epilepsy associated to AED withdrawal in epileptic children and to determine the risk factors of seizure recurrence. Methods and Materials: Two hundred – ninety two children between 1 year and 18 years of age with epilepsy who were seizure-free for at least 2 years and followed after drug withdrawal at a child neurology center between January 2015 and December 2020 were enrolled. Patients were classified into groups according to defined risk factors for recurrence. Results: 56 (19,1%) had recurrence of seizures; of these, 44,6% relapsed within the first 6 months after drug stopping and 55,4% after 6 months. The probability of remaining seizure free was 85% 1 year later, 83% at 2 years and 80% at 4 years. The mean age at the seizure onset was 7,1  3,48 years. In order to evaluate the risk of recurrence and the predictive factors of recurrence, several parameters were investigated by univariate and multivariate statistical analysis. Only age at seizure onset of 6 years older was the factor indicating a significantly higher recurrence risk. Conclusion: Although the decision to discontinue AED treatment necessitates evaluation of each patient individually, our study suggests that children with an age at seizure onset of 6 years older require more cautious follow-up after AED witdrawal because of the high risk of recurrence. Keywords: Antiepileptic drug, epileptic children, recurrence risk factors, withdrawal