What are the predominant predictors of seizure relapse following discontinuation of anti-seizure medication in epileptic children?
Epileptic Disord
; 25(2): 218-228, 2023 Apr.
Article
em En
| MEDLINE
| ID: mdl-37358927
ABSTRACT
OBJECTIVE:
The aim of the study was to identify the predominant predictors of seizure relapse following discontinuation of ASM in epileptic children.METHODS:
The study cohort consisted of 403 epileptic children who had a withdrawal process of ASM (monotherapy 344; dual therapy or polytherapy 59) after at least a 2-year seizure-free period. Patients were categorized if they had a well-defined epileptic syndrome. Epileptic children with ongoing ketogenic diet, vagal nerve stimulation, or surgery were excluded from the cohort due to the additional withdrawal process related to other therapy modalities.RESULTS:
The cohort's seizure relapse rate was 12.7% (51/403). The highest rates of seizure relapse were defined for genetic etiology at 25% and structural etiology at 14.9%. An epilepsy syndrome was defined in 183 of 403 children (45.4%). There was no difference in the seizure relapse rate between the subgroups of well-defined epileptic syndromes; 13.8% for self-limited focal epileptic syndromes, 11.7% for developmental and epileptic encephalopathies, and 7.1% for generalized epileptic syndromes. Five predictors were defined as the most powerful predictors of seizure relapse in univariateanalysis:
age at epilepsy diagnosis >2 years (hazard ratio [HR] 1.480; 95% confidence interval [CI] 1.134-1.933), defined etiology (HR 1.304; 95% CI 1.003-1.696), focal seizure (HR 1.499; 95% CI 1.209-1.859), ≤3 months duration of the withdrawal process (HR 1.654; 95% CI 1.322-2.070), and a history of neonatal encephalopathy with or without seizures (HR 3.140; 95% CI 2.393-4.122). In multivariate analysis, the main predictor of seizure relapse was a history of neonatal encephalopathy with or without seizures (HR 2.823; 95% CI 2.067-3.854).SIGNIFICANCE:
The duration of seizure freedom before discontinuation of ASM was not a predominant risk factor for seizure relapse 2-3 years versus >3 years. The predictive values of five predictors of seizure relapse rate should be evaluated for patients with different epilepsy subgroups.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Epilepsia Generalizada
/
Epilepsia
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Síndromes Epilépticas
Tipo de estudo:
Prognostic_studies
/
Risk_factors_studies
Limite:
Child
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Child, preschool
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Humans
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Newborn
Idioma:
En
Revista:
Epileptic Disord
Ano de publicação:
2023
Tipo de documento:
Article