, Candela Gómez Sánchez 2, Patricia Morte Coscolín 2, Maria Violeta Fariña Jara 3, Fernando Martínez Calvo 4, Ruth Fernando Martínez 21 Sección de Neuropediatría, Hospital Universitario Miguel Servet, 50009 Zaragoza, España
2 Servicio de Pediatría, Hospital Universitario Miguel Servet, 50009 Zaragoza, España
3 Sección de Neuropediatría, Hospital Parc Taulí, 08208 Sabadell, Barcelona, España
4 Sección de Neuropediatría, Hospital Quirón Salud, 50009 Zaragoza, España
Abstract
There are many variables to consider when withdrawing anti-epileptic seizure treatment and risk-benefit evaluation is required.
Retrospective study of patients from a neuropediatric clinic who were discontinued from pharmacological treatment for epilepsy and continued without treatment.
Of 57 children from whom treatment was withdrawn, 34 remained without treatment. In 23 cases, treatment was withdrawn once, with a mean seizure-free time until withdrawal of 21 months and a mean age of 10.5 years. Three cases presented seizures but treatment was not reintroduced; the average time without a crisis was 44.78 months. Treatment was withdrawn twice in nine children and three times in two children, with a mean seizure-free time until withdrawal of 28.5 months; the average age was 16.3 years. Two cases presented seizures but treatment was not reintroduced; the average time without a crisis was 5.7 years. High-risk cases of recurrent epileptic seizures were left without anti-seizure medication: seven cases of intellectual disability, one refractory epilepsy, two cases of epilepsy with onset in adolescence, and in 11 children, 13 instances of failure in previous withdrawal attempts.
The indication and maintenance of treatment with anti-seizure drugs in children must prioritize patient welfare and be based on three premises: the treatment is indicated, the treatment is tolerated, and the treatment is effective. The decision to withdraw must be made on a case-by-case basis, acknowledging the risk of relapse and taking into account efficacy and tolerance, especially in children with behavioral and neurodevelopmental disorders.
Keywords
- epilepsy
- anti-seizure drugs
- development disorders
- paediatrics
- withdrawal of anti-seizure drugs
References
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