Paudel Sita, Heebner Madison, Mainali Gayatra, Tencer Jaclyn S, Kanwar Rhea, Martel Katherine, Kumar Ashutosh, Naik Sunil C, Pradhan Sandeep, Kandel Prakash, Leslie Douglas
Department of Pediatrics and Neurology, Penn State Health Children's Hospital.
College of Medicine, Hershey, PA, USA.
J Child Neurol. 2025 Mar;40(3):200-207. doi: 10.1177/08830738241292836. Epub 2024 Dec 10.
BackgroundMost patients with idiopathic generalized epilepsy have good seizure control on antiseizure medications. Although idiopathic generalized epilepsy subtypes such as juvenile absence epilepsy and juvenile myoclonic epilepsy have a high risk of relapse, childhood absence epilepsy may have seizure remission. After 2 years of seizure freedom in childhood absence epilepsy, typically antiseizure medications are discontinued, but follow-up protocols are unclear. This study aims to evaluate how often patients with idiopathic generalized epilepsy undergo electroencephalography (EEG) after antiseizure medication withdrawal, how often antiseizure medications are restarted based on EEG findings, and if this varies between physicians and advanced practice providers at our institution.MethodsThis was a retrospective chart review. Data were collected using electronic medical records of pediatric patients (<18 years) with idiopathic generalized epilepsy who were successfully weaned off antiseizure medications at Penn State Children's Hospital from 2010 to 2020.ResultsWe reviewed 1409 charts and found 52 patients meeting criteria. Seventeen of 52 patients (32%) had a repeat EEG within 6 months of antiseizure medication withdrawal following seizure freedom. Of those 17 patients, 3 (17.6%) had generalized epileptiform discharges on EEG. Of these 3 patients, 2 (66%) were restarted on antiseizure medications based on the abnormal EEG. None had seizure relapse.ConclusionObtaining a repeat EEG in patients after antiseizure medication withdrawal following seizure freedom is common. Patients with an abnormal EEG are often restarted on antiseizure medications, irrespective of clinical seizure relapse. Considering the high health care costs of EEGs and antiseizure medication side effects, we propose that if patients with idiopathic generalized epilepsy do well clinically following antiseizure medication withdrawal, EEGs may not be necessary.
背景
大多数特发性全身性癫痫患者通过抗癫痫药物能很好地控制癫痫发作。尽管青少年失神癫痫和青少年肌阵挛癫痫等特发性全身性癫痫亚型复发风险较高，但儿童失神癫痫可能会出现癫痫发作缓解。在儿童失神癫痫发作自由2年后，通常会停用抗癫痫药物，但后续随访方案尚不清楚。本研究旨在评估特发性全身性癫痫患者在停用抗癫痫药物后接受脑电图（EEG）检查的频率、根据EEG结果重新开始使用抗癫痫药物的频率，以及在我们机构中医生和高级执业提供者之间是否存在差异。
方法
这是一项回顾性病历审查。使用宾夕法尼亚州立大学儿童医院2010年至2020年成功停用抗癫痫药物的18岁以下特发性全身性癫痫儿科患者的电子病历收集数据。
结果
我们审查了1409份病历，发现52名患者符合标准。52名患者中有17名（32%）在癫痫发作自由后停用抗癫痫药物的6个月内进行了重复EEG检查。在这17名患者中，3名（17.6%）EEG上有全身性癫痫样放电。在这3名患者中，2名（66%）基于异常EEG重新开始使用抗癫痫药物。均无癫痫复发。
结论
癫痫发作自由后停用抗癫痫药物的患者进行重复EEG检查很常见。EEG异常的患者通常会重新开始使用抗癫痫药物，无论临床癫痫是否复发。考虑到EEG检查的高医疗成本和抗癫痫药物的副作用，我们建议，如果特发性全身性癫痫患者在停用抗癫痫药物后临床情况良好，可能无需进行EEG检查。
