Study finds it generally safe to withdraw anti-seizure medication in children with epilepsy

Epilepsy is a disorder characterized by the occurrence of two or more seizures. It affects more than 3 million Americans. Approximately 10 percent of affected children have intractable epilepsy, a condition in which medications alone do not control seizures and seizures have a disabling effect on quality of life.

"It is often recommended that children with epilepsy who become seizure-free on anti-seizure medications be withdrawn from the drugs to avoid side effects of long-term use. Those potential side effects include cognitive slowing, incoordination, weight change, behavioral decline, and liver damage," says Katherine Nickels, M.D., a Mayo Clinic pediatric neurologist and an author of this study. "However, few previous studies had examined the risk of intractable epilepsy following withdrawal of anti-seizure medication, and the reported risks varied widely."

Dr. Nickels and a team of Mayo Clinic researchers set out to determine the frequency of intractable epilepsy in children who withdrew from anti-seizure medication after a period of seizure-freedom. The team reviewed the records of 241 children, ages 1 month to 16 years, who were diagnosed with new-onset epilepsy between 1990 and 2000. They identified 152 children who were diagnosed and treated with anti-seizure medication and had at least five years of follow-up. Of those, 56 children (37 percent) achieved seizure-freedom and were withdrawn from the medication. After an average follow-up of eight years, 20 children (36 percent) experienced at least one seizure recurrence. Fifteen of these children re-started the anti-seizure medication, and eight (53 percent) achieved seizure-freedom within one year, two (13 percent) achieved seizure-freedom after two years and only three (20 percent) developed intractable epilepsy. Overall, only 5 percent of the 56 children who withdrew from anti-seizure medication following seizure-freedom developed intractable epilepsy.

"The risk of children developing intractable epilepsy after withdrawal of anti-seizure medication was only 5 percent, which is similar to the risk of intractable epilepsy at the time of initial diagnosis of epilepsy in children," says Dr. Nickels. "Therefore, the children who achieve seizure-freedom on anti-seizure medication should be considered for withdrawal without high risk of intractable epilepsy."

Source: Mayo Clinic