Lower risk of seizure recurrence with levetiracetam and oxcarbazepine after withdrawal in pediatric epilepsy: a pilot study.

INTRODUCTION

There is no consensus on the optimal timing for discontinuing antiseizure medications (ASMs) and the associated risk factors for seizure recurrence in children with epilepsy. This study aimed to assess the ideal timing for discontinuation, the frequency and predictors of seizure recurrence, the risk factors associated with the cessation of ASMs and the potential impact of specific ASMs on seizure recurrence in children with epilepsy.

METHODS

The study included 211 children aged between one month and fifteen years who had been treated with ASMs and were followed for a minimum of two years after medication withdrawal.

RESULTS

The overall seizure recurrence rate was 30% with 75% of these recurrences occurring during the tapering period and within the first year after ASM withdrawal. The risk of seizure recurrence was significantly lower in patients using levetiracetam and oxcarbazepine compared to those taking valproate and carbamazepine. Specifically, the seizure recurrence rates were significantly lower in levetiracetam group than valproate (p = 0.006) and carbamazepine (p = 0.025) groups. Similarly, children taking oxcarbazepine experienced fewer seizure recurrences compared to those receiving carbamazepine (p = 0.011). In multivariate Cox regression analysis, a treatment duration less than three years was identified as the main risk factor for seizure recurrence (OR: 2.974, CI: 1.684-5.252, p value: 0.001).

CONCLUSION

The risk of seizure recurrence was lower in patients treated with newer generation ASMs, levetiracetam and oxcarbazepine compared to those using valproate and carbamazepine. We suggest that ASMs should be continued for at least three years before considering treatment discontinuation.