Risk of Seizure Recurrence after Withdrawal of Antiepileptic Drugs in Multiply Handicapped Egyptian Children with Epilepsy

Objectives: To determine the incidence and risk factors of seizure recurrence in multihandicapped Egyptian children with epilepsy after withdrawal of antiepileptic drugs (AEDs).

Methods: This was a prospective study from January 1995 to January 2016. The study population was multihandicapped children with epilepsy followed up in the outpatient clinic of Centre for Children with Special Needs; Egyptian Integrated Care Association (CCSN; EICA), Cairo, Egypt. The eligible children were less than 13 years, seizure-free for at least 24 months, with two normal EEG records, separated by 6 months. The AEDs were withdrawn slowly. The patients were then followed up to look for seizure recurrence.

Results: One hundred sixty-two children were recruited in the study. The average age of onset of epilepsy was 14 months. Most patients had partial seizures (49%). Most were controlled on monotherapy (64.2%), and were treated with Phenytoin (24%), Carbamazepine (20.4%), and Sodium valproate (16%). The seizure free duration before starting to withdraw AED was 48.3±9 months. None of the patients had seizure recurrence while the AEDs were being tapered. There were 77 patients (47.5%) with seizure recurrence. The average duration of follow-up for the patients who did not have seizure recurrence was 45±3 months. Most of recurrences occurred in the first twelve months, remainder during next twelve months. The risk factors of seizure recurrence were abnormal neurological examination, the need for use of polytherapy, presence of abnormal findings on brain imaging (CT and/or MRI).

Conclusion: Risk of seizure recurrence after AED withdrawal in multiply handicapped Egyptian children was high at 47.5%.