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What are the predictors for seizure relapse after stopping anti-seizure medication in the childhood population?

Objectives. The criteria for withdrawal of anti-seizure medications (ASM) process and the predictors for seizure recurrence after withdrawal have been controversial. To identify the predominant predictors for seizure recurrence after stopping ASM in epileptic children. Methods. The study cohort consisted of 403 epileptic children who had ASM stopping after a seizure-free period of at least 2 years with a tapering dose over 2-3 months. We evaluated 17 evidence-based risk factors for seizure relapse after stopping ASM in children: gender, age at epilepsy diagnosis, etiology, epileptic syndrome, neurologic examination, intellectual disability, magnetic resonance imaging (MRI), seizure onset (focal/generalized), multiple seizure semiology, seizure after ASM initiation, monotherapy/polytherapy, EEG before ASM discontinuation, duration of the withdrawal process ( 3 or > 3 months), status epilepticus, febrile seizures, neonatal seizures, family history of seizures. Results. Seizures recurrence rate was 12.7% (n= 51). MRI did not reveal structural abnormalities in 346 of 403 (85.8%) patients. The epileptic syndromes were self-limited with 88.5% and catastrophic with 11.5%in the cohort. Among the 17 risk factors, four predictors were defined: epileptiform discharges on EEG before ASM discontinuation, duration of ASM withdrawal months, febrile seizures, and neonatal seizures (odds ratios=3.4, 2.1, 2.5, 2.9, respectively). Duration of seizure freedom before stopping ASM was not a predominant risk factor for seizure recurrence in the cohort: 2-3 years versus >3 years (p>0.05). Conclusion. Stopping ASMs after at least 2 years of seizure-free period and over a reasonable tapering period of 3 months has a low risk of seizure recurrence with 12.7%.
Keywords: anti-seizure medication , seizure recurrence