RANDOMIZED PROSPECTIVE-STUDY OF EARLY DISCONTINUATION OF ANTIEPILEPTIC DRUGS IN CHILDREN WITH EPILEPSY

We studied recurrence rate, risk factors for recurrence, and outcome a fter recurrence in children after early withdrawal of antiepileptic dr ugs (AEDs). One hundred sixty-one children with newly diagnosed epilep sy who had become seizure free within 2 months after starting treatmen t and remained so for 6 months were randomly assigned to immediate wit hdrawal of AEDs (n = 78) or continuation of treatment for another 6 mo nths followed by withdrawal (n = 83). The probability of remaining sei zure free at 24 months after randomization was 51% (95% CI, 40 to 62) in Group A and 52% (41 to 63) in Group B. Significant predictive facto rs for relapse were partial epilepsy, seizure onset at 12 years or old er, defined etiology, and epileptiform EEG before randomization. At th e end of follow-up (median, 41.9 months), 129 children (80.6%) had a t erminal remission of at least 1 year, 88 without AEDs and 41 with AEDs . No significant difference in outcome was found between Groups A and B. In children with epilepsy and an early response to therapy, AED wit hdrawal after 6 or 12 months of treatment leads to seizure recurrence in approximately half of all patients regardless of the duration of th erapy. More than 60% of those with one or more recurrences reach a ter minal remission of at least 1 year after long-term follow-up with or w ithout AEDs.