Predicting seizure recurrence risk in pediatric epilepsy patients who are seizure free and stopped Anti-Epileptic Drugs

Introduction: Antiepileptic drugs suppress seizures in 65% to 85% of people with epilepsy with significant impact on physical, psycho-socio-academic aspects of children and adolescents. Withdrawal of these drugs remain controversial even after prolonged seizure freedom. Aims and objectives: 1.To predict risk of relapse in seizure free children using Epilepsy prediction tool. 2. To identify the risk factors of relapse. Material and Methods: In a retro-prospective study including 100 children under 18 years by using EPT with a set of questionnaire, children were categorized into 3 groups of EPT score less than 30%, 30% to 60% and above 60% were followed up to 2 years or till they got relapse. Results: Relapse rate in our study was observed to be 24%. Percentage of relapse rate was observed to be 0, 28.88 and 60 percent for groups with EPT score less than 30, 30-60 and more than 60 percent respectively. Overall sensitivity of EPT score is 74.07%, specificity is 94.52% with PPV of 83.33% and NPV of 90.79%, p-value of EPT tool is less than 0.0001. Identified risk factors were age at onset, duration, history of febrile seizures, number of seizure episodes, no. of AEDs used and abnormal EEG pattern. Conclusion: EPT was observed to overestimate the risk of relapse than the actual recurrence. It is more likely to be useful for low risk group than the high risk group. Risk factors identified – children on >3 drugs and epileptiform EEG before withdrawal.
Keywords: Epilepsy prediction tool, relapse, recurrence risk, risk factors