Treatment and Discontinuation of Antiepileptic Drugs in Childhood Epilepsy: A Clinical and Electroencephalographic Study Key Words: antiepileptic drug
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1 Treatment and Discontinuation of Antiepileptic Drugs in Childhood Epilepsy: A Clinical and Electroencephalographic Study Key Words: antiepileptic drugs, discontinuation, childhood epilepsy, treatment, EEG. Yoko Ohtsuka Department of Pediatrics, and Department of Developmental Neuroscience and Child Neurology, Institute for Neurobiology, Okayama University Medical School, Okayama
2 Table 1 Patients Table 2 Seizure-free period and prognosis after discontinuation ( ) shows percentages,[ ] shows the number of cases whose EEGs were examined after discontinuation
3 Table 3 Spike-free period and prognosis after discontinuation a) b) ( ) shows percentages,[ ] shows the number of cases whose EEGs were examined after discontinuation
4 Table 4 Seizure-free period, spike-free period and prognosis after discontinuation Table 5 Prognosis in the cases free from clinical seizures for over three years at the time of drug withdrawal ( ) shows percentages,[ ] shows the number of cases whose EEGs were examined after discontinuation
5 Table 6 Seizure type at initial visit and prognosis after discontinuation Table 7 Change of seizure types and prognosis after discontinuation of cases whose EEGs were examined after discontinuation
6
7 Table 8 Interval between the disontinuation and relapse of seizures shows one case without epileptic discharge at the time of drug withdrawal shows one case with epileptic discharge at the time of drug withdrawal
8 Table 9 Epileptic discharge and prognosis after discontinuation
9
10 1) Alvarez N, Lombroso CT, Medina C, Canton B. Paroxysmal spike and wave activity in drowsiness in young children: its relationship to febrile convulsions. Eletroenceph Clin Neurophysiol 1983; 56: ) Annegers JF, Hauser WA, Elveback LR. Remission of seizures and relapse in patients with epilepsy. Epilepsia 1979; 20: ) Emerson R, D'Souza BJ, Vining EP, Holden KR, Mellits ED, Freeman JM. Stopping medication in children with epilepsy: Predictors of outcome. N Engl J Med 1981; 304: ) Hedenstrom I, Schorsch G. Klinische und hirnelektrische Befunde bei 120 anfallsfrei gewordenen Epileptikern. Arch Psychiat Zschr f d ges Neurol 1958; 198: ) Hess R. Verlaufsuntersuchungen aber Anfalle und EEG bei kindlichen Epilepsien. ibid 1958; 197: ) Holowach J, Thurston DL, O'Leary J. Prognosis in childhood epilepsy: Follow-up study of 148 cases in which therapy had been suspended after prolonged anticonvulsant control. N Engl J Med 1972; 286: ) Juul-Jensen P.Frequency of recurrence after discontinuance of anticonvulsant therapy in patients with epileptic seizures. Epilepsia 1964; 5:
11 9) Juul-Jensen P.Frequency of recurrence after discontinuance of anticonvulsant therapy in patients with epileptic seizures: A new followup study after 5 years. Epilepsia 1968; 9: 11- Advances in Epileptology: The Xth Epilepsy with epilepsy. In: Wada JA and Penry JK, ed, 16. International Symposium. New York: Raven Press, 1980; ) Kuhl V, Kiorboe E, Lund M. The prognosis of epilepsy with special reference to traffic security. Epilepsia 1967; 8: ) Livingston S. Comprehensive Management of Epilepsy in Infancy, Childhood and Adolescence. Illinois: CC Thomas, 1972; ) Lundervold A. A prognostic evaluation of clinical, electroencephalographic and roentgeno- graphic findings in children with epilepsy. Epilepsia 25) Thurston JH, Thurston DL, Hixon BB, Keller 1964; 5: ) Merritt HH. Medical treatment in epilepsy. Br AJ. Prognosis in childhood epilepsy. Additional follow-up study of 148 children 15 to 23 years Med.J 1958; 1: after withdrawal of anticonvulsant therapy. N Engl J Med 1982; 306: ) Yahr MD, Sciarra D, Carter S, Merritt HH. 17) Ohtahara S, Yamatogi Y, Ohtsuka Y, Oka E, Evaluation of standard anticonvulsant therapy Kanda S. Prognosis in childhood epilepsy: A in three hundred nineteen patients. JAMA 1952; prospective follow-up study. Folia Psychiat 150: Neurol Jpn 1977; 31: ) Oller-Daurella L, Pamies R, Oller, L. Reduction or discontinuance of antiepileptic drugs in patients seizure-free for more than 5 years. In: Janz D.ed, Epileptology, Stuttgart: Thieme- Verlag, 1976; ) Rodin EA. Medical and social prognosis in epilepsy. Epilepsia 1972; 13: ) Rodin EA, John G. Withdrawal of anticonvulsant medications in successfully treated patients 29) Zenker Ch, Groh Ch, Roth G. Probleme and Erfahrungen beim Absetzen antikonvulsiver Therapie. Neue Ost Z Kinderheilk 1957; 2: Summary Treatment and Discontinuation of Antiepileptic Drugs in Childhood Epilepsy: A Clinical and Electroencephalographic Study Yoko Ohtsuka The process of discontinuing anticonvulsant medication was studied clinico-electroencephalographically on 285 children with epilepsy. The observation period after discontinuation of anticonvulsants was ranged from two years to 10 years and one month. The subjects were divided into two groups electroencephalographically: 190 cases in which antiepileptic drugs were formally disconitnued after the complete suppression of epileptic discharge for over two years, and 95 cases in which anticonvulsants were informally discontinued. The relapse rate after discontinuation was significantly lower
12 in the former group, 2.1%, than the latter group, 21.1%. Concerning the seizure-free period, the group of cases free from clinical seizures for over three years by the time of withdrawal showed significantly lower relapse rate than the rest of the cases. Since the relapse of clinical seizures was related to both the snike-free perind and the seizure-free period, the interrelationship between these factors was studied further - more. As the result the spike-free period proved to be a more reliable indirator for stopping medication than the seizure-free period. From these findings, the withdrawal of antiepileptic drugs should be started after suppression of epileptic discharges for over two years in childhood epilepsy. However, since each epileptic patient is based on different pathophysiology and etiology, the discontinuation of antiepileptic drugs should be determined not only electroencephalographically, but also taking various clinical factors into consideration comprehensively. J. Jpn. Epil. Soc. 1984; 2:
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