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From the Department of Neurology (Drs. Peters and Brouwer), Leiden University Medical Centre, Leiden; the Department of Public Health (A.T. Geerts), Erasmus University, Rotterdam; the Department of Neurology (Dr. Arts), Westeinde Hospital and Juliana Children's Hospital, The Hague; the Department of Neurology (Drs. Stroink and van Donselaar), University Hospital Rotterdam-Dijkzigt and Sophia Children's Hospital, Rotterdam, The Netherlands.
Address correspondence and reprint requests to DrB. Peters, Department of Child Neurology, University Hospital Utrecht and Wilhelmina Children's Hospital, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
We studied recurrence rate, risk factors for recurrence, and outcome after recurrence in children after early withdrawal of antiepileptic drugs (AEDs). One hundred sixty-one children with newly diagnosed epilepsy who had become seizure free within 2 months after starting treatment and remained so for 6 months were randomly assigned to immediate withdrawal of AEDs (n = 78) or continuation of treatment for another 6 months followed by withdrawal (n = 83). The probability of remaining seizure 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 factors for relapse were partial epilepsy, seizure onset at 12 years or older, defined etiology, and epileptiform EEG before randomization. At the end of follow-up (median, 41.9 months), 129 children (80.6%) had a terminal 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 withdrawal after 6 or 12 months of treatment leads to seizure recurrence in approximately half of all patients regardless of the duration of therapy. More than 60% of those with one or more recurrences reach a terminal remission of at least 1 year after long-term follow-up with or without AEDs.
Supported by the National Epilepsy Fund, Houten, The Netherlands (A 72 and A 85) as part of the Dutch Study of Epilepsy in Childhood.
Presented in part at the 21st International Epilepsy Congress, Sydney, Australia, September 3 to 8, 1995.
Received December 11, 1996. Accepted in final form November 7, 1997.
This article has been cited by other articles:
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  J. G. Serra, M. A. Montenegro, and M. M. Guerreiro Antiepileptic Drug Withdrawal in Childhood: Does the Duration of Tapering Off Matter for Seizure Recurrence? J Child Neurol, July 1, 2005; 20(7): 624 - 626. [Abstract] [PDF]
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 A. T. Geerts, J.M.F. Niermeijer, A. C.B. Peters, W. F.M. Arts, O. F. Brouwer, H. Stroink, E. A.J. Peeters, and C. A. van Donselaar Four-year outcome after early withdrawal of antiepileptic drugs in childhood epilepsy Neurology, June 28, 2005; 64(12): 2136 - 2138. [Abstract] [Full Text] [PDF]
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 P Kwan and J W Sander The natural history of epilepsy: an epidemiological view J. Neurol. Neurosurg. Psychiatry, October 1, 2004; 75(10): 1376 - 1381. [Abstract] [Full Text] [PDF]
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 W. F. M. Arts, O. F. Brouwer, A. C. B. Peters, H. Stroink, E. A. J. Peeters, P. I. M. Schmitz, C. A. van Donselaar, and A. T. Geerts Course and prognosis of childhood epilepsy: 5-year follow-up of the Dutch study of epilepsy in childhood Brain, August 1, 2004; 127(8): 1774 - 1784. [Abstract] [Full Text] [PDF]
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K. Y. Hawash and N. P. Rosman Do Partial Seizures Predict an Increased Risk of Seizure Recurrence After Antiepilepsy Drugs Are Withdrawn? J Child Neurol, May 1, 2003; 18(5): 331 - 337. [Abstract] [PDF]
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P. Camfield and C. Camfield Childhood Epilepsy: What Is the Evidence for What We Think and What We Do? J Child Neurol, April 1, 2003; 18(4): 272 - 287. [Abstract] [PDF]
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H. Stroink, C.A. van Donselaar, A.T. Geerts, A.C.B. Peters, O.F. Brouwer, and W.F.M. Arts The accuracy of the diagnosis of paroxysmal events in children Neurology, March 25, 2003; 60(6): 979 - 982. [Abstract] [Full Text] [PDF]
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S. C. Schachter Drug-mediated antiepileptogenesis in humans Neurology, November 12, 2002; 59(90095): S34 - 35. [Abstract] [Full Text]
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P A D Bouma, A C B Peters, and O F Brouwer Long term course of childhood epilepsy following relapse after antiepileptic drug withdrawal J. Neurol. Neurosurg. Psychiatry, April 1, 2002; 72(4): 507 - 510. [Abstract] [Full Text] [PDF]
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S. Shinnar and J. M. Pellock Update on the Epidemiology and Prognosis of Pediatric Epilepsy J Child Neurol, January 1, 2002; 17(1_suppl): S4 - S17. [Abstract] [PDF]
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 R. S. Greenwood and M. B. Tennison When to Start and Stop Anticonvulsant Therapy in Children Arch Neurol, September 1, 1999; 56(9): 1073 - 1077. [Abstract] [Full Text] [PDF]
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