DISCONTINUING ANTIEPILEPTIC DRUGS IN CHILDREN WITH EPILEPSY - A COMPARISON OF A 6-WEEK AND A 9-MONTH TAPER PERIOD

Background. The optimal regimen for discontinuing antiepileptic medica tions in children with epilepsy is unknown. Methods. We randomly assig ned 149 children to either a six-week or a nine-month period of drug t apering, after which therapy was discontinued. Each group was composed of patients who had been seizure-free for either two or four years be fore drug tapering was begun. Most patients were receiving one antiepi leptic drug; none were taking more than two. The children were evaluat ed periodically during and after the taper period. Sixteen patients we re lost to follow-up before the beginning of the taper period. Proport ional-hazards regression analysis was used to assess the risk of seizu re recurrence among the remaining 133 patients. Results. Seizures recu rred in 53 patients (40 percent). The mean duration of follow-up was 3 9 months (range, 11 to 105) for the patients who did not have a recurr ence of seizures. Neither the length of the taper period (six weeks vs , nine months, P = 0.38) nor the length of time the patients were free of seizures before the taper period was begun (two years vs. four yea rs, P = 0.20) significantly influenced the risk of seizure recurrence. The presence of mental retardation (relative risk, 3.1; 95 percent co nfidence interval, 1.5 to 6.2) or spikes in the electroencephalogram a t the time of tapering (relative risk, 1.9; 95 percent confidence inte rval, 1.0 to 3.4) increased the risk of seizure recurrence. Conclusion s. The risk of seizure recurrence during drug tapering and after the d iscontinuation of antiepileptic drug therapy in children with epilepsy is not different whether the medications are tapered over a six-week or a nine-month period.