Risk Factors for Seizure Recurrence After Initial Withdrawal of Anti-Seizure Medication in Childhood Epilepsy

ABSTRACT TITLE: Risk Factors for Seizure Recurrence After Initial Withdrawal of Anti-Seizure Medication in Childhood Epilepsy OBJECTIVES: To determine risk factors associated with seizure recurrence following withdrawal of anti-seizure medications (ASM) among children with epilepsy. METHODS: This was a retrospective observational study of children aged between 2 and 18 years with a diagnosis of epilepsy who underwent withdrawal of ASM following seizure remission. All eligible medical records between January 2011 and December 2019 were included. Demographic, clinical, imaging and electro-encephalography details of all eligible patients were analyzed against seizure remission within 24 months after withdrawal of ASM, using appropriate parametric and non-parametric tests. RESULTS: A total of 49 records of children who underwent withdrawal of ASM out of a total of 613 patients on follow up during the same period were included. The median age at ASM withdrawal was 70 months (IQR 52-112 months) and 14 (28.6%) were female. Thirteen patients (26.5%) had seizure recurrence within 24 months following withdrawal of ASM. Focal seizure type was associated with significant risk of relapse (OR 13.7; 95% CI 0.97, 193.54; P value = 0.011). Age at epilepsy diagnosis, abnormal EEG at initiation of treatment and before de-escalation, abnormal MRI findings, first or second degree relative with epilepsy, history of developmental delay, seizure burden, use of 2 or more ASMs and duration of seizure-freedom before de-escalation were not associated with increases risk of relapse. CONCLUSION: Focal seizure type is associated with increased with risk of seizure recurrence in our cohort.
Keywords: Epilepsy, risk factors, withdrawal, anti-seizure medications, children