It's generally safe to stop giving anti-seizure medication to children with epilepsy who've achieved seizure-freedom while on the medication, because these children aren't at high risk of later developing intractable epilepsy, a Mayo Clinic study finds.
Intractable epilepsy, which affects about 10 percent of children with epilepsy, is a condition in which medications alone don't control seizures and in which seizures have a disabling effect on the patient's quality of life.
"It is often recommended that children with epilepsy who become seizure-free on anti-seizure medications be withdrawn from the drugs to avoid side effects of long-term use. Those potential side effects include cognitive slowing, incoordination, weight change, behavioral decline, and liver damage," pediatric neurologist Dr. Katherine Nickels said in a Mayo news release. "However, few previous studies had examined the risk of intractable epilepsy following withdrawal of anti-seizure medication, and the reported risks varied widely."
In this study, Nickels and colleagues reviewed the records of 152 children, ages 1 month to 16 years, who were diagnosed with new-onset epilepsy between 1990 and 2000 and treated with anti-seizure medication. Of those children, 56 (37) percent achieved seizure-freedom and were taken off their medication.
After an average follow-up of eight years, 20 of the 56 children experienced at least one seizure recurrence. Fifteen of those 20 children re-started treatment with anti-seizure medication. Eight of those 15 achieved seizure-freedom within one year, two achieved seizure-freedom after two years, and three developed intractable epilepsy. Overall, intractable epilepsy developed in 5 percent of the 56 children who were taken off anti-seizure medication following seizure-freedom, the study found.
"The risk of children developing intractable epilepsy after withdrawal of anti-seizure medication was only five percent, which is similar to the risk of intractable epilepsy at the time of initial diagnosis of epilepsy in children," Nickels said. "Therefore, the children who achieve seizure-freedom on anti-seizure medication should be considered for withdrawal without high risk of intractable epilepsy."
The study was to be presented Dec. 7 in Seattle at the annual meeting of the American Epilepsy Society.
More information
The Epilepsy Foundation has more about epilepsy.
SOURCE: Mayo Clinic, news release, Dec. 7, 2008
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