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Drug withdrawal: which children are most at risk of seizure recurrence?

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When a person with epilepsy has been seizure-free for a considerable period (decided by both the patient and doctor), the possibility of withdrawing their anti-epileptic drug (AED) is considered, despite the risk of seizure recurrence.

In children, the risk of recurrence is approximately 20-40%. However there is currently no general agreement amongst specialists, on how to predict the safety of AED discontinuation.

In light of this, doctors at Hacettepe University, in Turkey, recently performed a retrospective study in children with epilepsy, to determine the risk of seizure recurrence (and other related consequences) after AED withdrawal.

They included a group of 200 epileptic children (118 boys, 82 girls), aged between 1 month and 15 years, who had been followed at least 1 year after drug withdrawal at a child neurology center.

Amongst the 200 children, the overall seizure recurrence rate was 27%. Interestingly, the researchers found that girls were more likely to have a seizure recurrence than boys.

When they looked at post-drug-withdrawal EEG recordings, the scientists discovered abnormalities in the majority of the children who then went on to have seizure recurrence.

Although further research is needed, these findings suggest that female sex and abnormal post-withdrawal EEG could be key risk factors influencing seizure recurrence in children.

The decision to stop AED treatment can only be taken after careful evaluation of each individual patient. However this study is useful, because it alerts specialists that girls might require particularly close follow-up after withdrawal. It also highlights the potential importance of post-withdrawal EEGs in predicting the safety of drug discontinuation.

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