Central European Journal of Medicine

, Volume 5, Issue 2, pp 251–256 | Cite as

Determination of risk factors associated with seizure relapse after antiepileptic drug withdrawal

  • Sebahattin Vurucu
  • Mehmet Saldir
  • Bulent Unay
  • Ridvan Akin
Research Article


There is no consensus regarding the time of antiepileptic drug withdrawal and the relevant risk factors for seizure relapse. In this study, we aimed to determine the seizure relapse rates and the associated risk factors for seizure relapse in childhood epilepsy. Two-hundred sixty-six epileptic patients who discontinued the antiepileptic drug therapy after a seizure-free period of at least two years, were enrolled into the study. The data of the patients regarding sex, febrile convulsion history, family history, age at onset, type of epilepsy, total number of seizures and antiepileptic drugs, seizures during treatment, mental status, first and last electroencephalography, brain imaging findings, etiological factors and seizure relapse in the first two years after antiepileptic drug withdrawal were obtained from the patients’ files. Univariate logistic regression analysis was performed for each variable. The variables which were found to be statistically significant in univariate analysis, were included in multivariate logistic regression analysis. The overall seizure relapse rate after antiepileptic drug withdrawal was 19.2%. There were no significant differences for seizure relapse rate after antiepileptic drug withdrawal between patient groups with respect to sex, family history, type of epilepsy, febrile convulsion history, seizures before treatment, first electroencephalography findings, brain imaging findings and etiology. However, there were statistically significant differences for seizure relapse rate among patient groups concerning age at onset of epilepsy, new seizure during treatment, the total number of antiepileptic drugs, mental status, and last electroencephalography findings. We imply that the clinical status of the patients should be considered before the cessation of drug therapy rather than the etiological factors or laboratory findings.


Antiepileptic drug withdrawal Seizure relapse Risk factors Children 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. [1]
    Guerrini R., Epilepsy in children. Lancet, 2006, 367, 499–524CrossRefPubMedGoogle Scholar
  2. [2]
    Forsgren L., Epidemiology in epilepsy. Epilepsy primarily affects small children and the elderly. Lakartidningen, 1997, 94, 1899–1902PubMedGoogle Scholar
  3. [3]
    Hauser WA., Annegers J.F., Kurland L.T., Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia, 1993, 34, 453–468CrossRefPubMedGoogle Scholar
  4. [4]
    Tsuboi T., Prevalence and incidence of epilepsy in Tokyo. Epilepsia, 1988, 29, 103–110CrossRefPubMedGoogle Scholar
  5. [5]
    Ohta H., Ohtsuka Y., Tsuda T., Oka E., Prognosis after withdrawal of antiepileptic drugs in childhood-onset cryptogenic localization-related epilepsies. Brain Dev., 2004, 26, 19–25CrossRefPubMedGoogle Scholar
  6. [6]
    Sillanpää M., Remission of seizures and predictors of intractability in long-term follow-up. Epilepsia, 1993, 34, 930–936CrossRefPubMedGoogle Scholar
  7. [7]
    Holowach J., Thurston D.L., 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, 169–174PubMedGoogle Scholar
  8. [8]
    Aicardi J., Epilepsy in children, second ed., Raven, New York, 1994, 402–428Google Scholar
  9. [9]
    Greenwood R.S., Tennison M.B., When to start and stop anticonvulsant therapy in children. Arch. Neurol., 1999, 56, 1073–1077CrossRefPubMedGoogle Scholar
  10. [10]
    Emerson R., D’souza B.J., Vining E.P., Holden K.R., Mellits E.D., Freeman J.M., Stopping medication in children with epilepsy. N. Engl. J. Med., 1981, 304, 1125–1129PubMedGoogle Scholar
  11. [11]
    Shinnar S., Berg A.T., Moshe S.L., Discontinuing antiepileptic drugs in children with epilepsy: a prospective study. Annals of Neurology, 1994, 35, 534–545CrossRefPubMedGoogle Scholar
  12. [12]
    Arts W.F., Visser L.H., Loonen M.C.B., Follow-up of 146 children with epilepsy after withdrawal of antiepileptic drugs. Epilepsia, 1988, 29, 244–250CrossRefPubMedGoogle Scholar
  13. [13]
    Tennison M., Greenwood R., Lewis D., Thorn M., Discontinuing antiepileptic drugs in children with epilepsy. A comparison of a six-week and a ninemonth taper period. N. Engl. J. Med., 1994, 330, 1407–1410CrossRefPubMedGoogle Scholar
  14. [14]
    Altunbasak S., Artar O., Burgut R., Yildiztas D., Relapse risk analysis after drug withdrawal in epileptic children with uncomplicated seizures. Seizure, 1999, 7, 384–389CrossRefGoogle Scholar
  15. [15]
    Mastropolo C., Tondi M., Carboni F., Manca S., Zoroddu F., Prognosis after therapy discontinuation in children with epilepsy. European Neurology, 1992, 32, 141–145CrossRefGoogle Scholar
  16. [16]
    Daoud A.S., Ajloni S., El-Salem K., Horani K., Otoom S., Daradkeh T., Risk of seizure recurrence after a first unprovoked seizure: a prospective study among Jordanian children. Seizure, 2004, 13, 99–103CrossRefPubMedGoogle Scholar
  17. [17]
    Donati F., Hassink R.I., Jung H., Vassella F., Factors predicting the risk of relapse after antiepileptic drug discontinuation in children with partial seizures. Eur. J. Pediatr., 1995, 154, 44–47CrossRefGoogle Scholar
  18. [18]
    Sillanpaa M., Jalava M., Kaleva O., Shinnar S., Long-term prognosis of seizures with onset in childhood. N. Engl. J. Med., 1998, 338, 1715–1722CrossRefPubMedGoogle Scholar
  19. [19]
    Berg A.T., Shinnar S., Levy S.R., Testa S.M., Testa F.M., Smith-Rapaport S., et al., Two-year remission and subsequent relapse in children with newly diagnosed epilepsy. Epilepsia, 2001, 42, 1553–1562CrossRefPubMedGoogle Scholar
  20. [20]
    Gross-Tsur V., Shinnar S., Discontinuing antiepileptic drug treatment. In: Wyllie E, editor. The treatment of epilepsy: principles and practice, second ed. Baltimore, MD: Williams and Wilkins. 1996, 799–807Google Scholar
  21. [21]
    Ishiguro Y., Okumura A., Nomura K., Watanabe K., Negoro T., Takada H., et al., A pilot study on benign partial epilepsy in children with complex partial seizures. Seizure, 2001, 10, 194–196CrossRefPubMedGoogle Scholar
  22. [22]
    Gherpelli J.L., Kok F., dal Forno S., Elkis L.C., Lefevre B.H., Diament A.J., Discontinuing medication in epileptic children: a study of risk factors related to recurrence. Epilepsia, 1992, 33, 681–686CrossRefPubMedGoogle Scholar
  23. [23]
    Scotoni A.E., Manreza M.L., Guerreiro M.M., Recurrence after a first unprovoked cryptogenic/idiopathic seizure in children: a prospective study from Sao Paulo, Brazil. Epilepsia, 2004, 45, 166–170CrossRefPubMedGoogle Scholar
  24. [24]
    Boonluksiri P., Risk of seizure recurrence following a first unprovoked seizure in children. J. Trop. Pediatr., 2003, 49, 379–381CrossRefPubMedGoogle Scholar
  25. [25]
    Pearce J.L., Mackintosh H.T., Prospective study of convulsions in children. N.Z. Med. J., 1979, 89, 1–3PubMedGoogle Scholar
  26. [26]
    Elwes R.D.S., Chesterman P., Reynolds E.H., Prognosis after a first untreated tonic-clonic seizure. Lancet, 1985, 2, 752–753CrossRefPubMedGoogle Scholar
  27. [27]
    Stroink H., Brouwer O.F., Arts W.F., Geerts A.T., Peters A.C., van Donselaar C.A., The first unprovoked, untreated seizure in childhood: a hospital based study of the accuracy of the diagnosis, rate of recurrence, and long term outcome after recurrence. Dutch study of epilepsy in childhood. J. Neurol. Neurosurg. Psychiatry, 1998, 64, 595–600CrossRefPubMedGoogle Scholar
  28. [28]
    Berg A.T., Shinnar S., The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology, 1991, 41, 965–972PubMedGoogle Scholar
  29. [29]
    Wallis WE., Withdrawal anticonvulsant drug in seizure-free epileptic patient. Clin. Neuropharmacol., 1987, 10, 423–433CrossRefPubMedGoogle Scholar
  30. [30]
    Berg A.T., Shinnar S., Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology, 1994, 44, 601–608PubMedGoogle Scholar
  31. [31]
    Shinnar S., Vining E.P., Mellits E.D., D’souza B.J., Holden K., Baumgardner R.A., et al., Discontinuing antiepileptic medication in children with epilepsy after two years without seizers: a prospective study. N. Eng. J. Med., 1985, 313, 976–980CrossRefGoogle Scholar
  32. [32]
    Todt H., The late prognosis of epilepsy in childhood: results of a prospective follow-up study. Epilepsia, 1984, 25, 137–144CrossRefPubMedGoogle Scholar
  33. [33]
    Foorster C., Schmidthberger G., Prognosis in childhood epilepsy after discontinuation of therapy. Monatsschr. Kinderheilkd., 1992, 130, 225–228Google Scholar
  34. [34]
    Joul-Jensen P., Frequency of recurrence after discontinuation of anticonvulsant therapy in patients with epileptic seizures, new follow-up study after 5 years. Epilepsia, 1968, 9, 11–16CrossRefGoogle Scholar

Copyright information

© © Versita Warsaw and Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Sebahattin Vurucu
    • 1
  • Mehmet Saldir
    • 1
  • Bulent Unay
    • 1
  • Ridvan Akin
    • 1
  1. 1.Department of Pediatric NeurologyGulhane Military Medical AcademyEtlikTurkey

Personalised recommendations