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A Follow-Up Study after Discontinuation of Antiepileptic Drug Therapy in Children with Well-Controlled Epilepsy : The Factors that Influence Recurrence

Journal of the Korean Pediatric Society 2002;45(12):1559-1570.
Published online December 15, 2002.
A Follow-Up Study after Discontinuation of Antiepileptic Drug Therapy in Children with Well-Controlled Epilepsy : The Factors that Influence Recurrence
Sa Jun Chung1, Hye Jeon Chung1, Young Mi Choi1, Eu Hyun Cho2
1Department of Pediatrics, College of Medicine, Kyung-Hee University, Seoul, Korea
2Chungju Medical Center, Chungju, Korea
항전간제로 조절된 간질 환아에서 약물 중지 후 추적 관찰 - 재발위험인자
정사준1, 정혜전1, 최영미1, 조의현2
1경희대학교 의과대학 소아과학교실
2청주의료원
Correspondence: 
Sa Jun Chung, Email: sajchung@khmc.or.kr
Abstract
Purpose
: There has been no exact answer to the question of when to discontinue antiepileptic drugs(AEDs) in children with well-controlled epilepsy for a long period. This study is about the risk factors of relapse after withdrawal of AEDs in seizure(Sz)-free patients to show a guideline for discontinuation of AEDs.
Methods
: One hundred and sixty-nine children were diagnosed as epileptic at the Pediatric Dept. of Kyung-Hee Univ. between 1993 to 1998, in whom AEDs had been withdrawn after at least two years of Sz-free period. Univariate analysis using Kaplan-Meier survival analysis and multivariate analysis using Cox-proportional hazard model were performed for sixteen risk factors.
Results
: Forty-nine of the 169 patients(28.9%) had recurrence of Szs. The mean follow-up after withdrawal of AEDs was 4.1 years, mean treatment period was 4.1 years, and the mean Sz-free period was 3.3 years. Factors associated with an increased risk of relapse were young age at onset, symptomatic Sz, Sz type in West and Lennox-Gastaut syndrome, neurologic deficit, longer Sz-controlling period, shorter total treatment period, number of AEDs used(more than one drug), age at withdrawal of AEDs, and Sz-free period less than two years in univariate analysis using Kaplan-Meier mothod. From multivariate analysis, the factors indicating a significantly higher relapse risk were pre-treatment period after first Sz attack, Sz-controlling period, Sz-free period, number of AEDs used, neurologic abnormalities.
Conclusion
: For epileptic children who were Sz-free for more than two years, and were more than six-years-old, the discontinuation of AEDs should be considered positively, according to age of onset, Sz type, age at withdrawal of AEDs, total treatment period, Sz-controlling period, number of AEDs used, etiology, neurologic deficit, and the wishes of the patients and the their parents.
Key Words: Epilepsy, Relapse, Antiepileptic drugs, Seizure-free period, Risk factors


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