Recurrence of epilepsy and related risk factors after the discontinuation of antiepileptic drugs in children: A 10-year single-center study

Purpose: The criteria for discontinuing antiepileptic drugs (AEDs) in children with well-controlled epilepsy remain unclear. This study sought to identify the recurrence rate of epilepsy after the discontinuation of AEDs and the risk factors associated with recurrence. Methods: We retrospectively reviewed the records of 441 children who discontinued AEDs at our department of pediatrics from August 2007 to July 2017. AED tapering was performed in patients who were seizure-free for more than 2 years after taking AEDs, and patients were monitored for 1 year after the discontinuation of AEDs. Results: We found that 87 patients (87/441, 19.7%) experienced seizure recurrence within 1 year after the discontinuation of AEDs. Among them, 38 patients (38/87, 43.7%) experienced recurrence during AED tapering. The recurrence of seizures was related to the patient’s age at AED onset and when seizures were controlled, a history of seizure recurrence after previous discontinuation of AEDs or a seizure episode during AED administration, and no improvement of electroencephalographic (EEG) findings. Conclusion: The recurrence rate within 1 year after the discontinuation of AEDs was almost 20%, and nearly half of the recurrences took place during the tapering period. We recommend caution when considering whether to discontinue AEDs in patients with a history of seizure recurrence after AED discontinuation, a seizure episode during AED administration, or no (or slight) improvement of EEG findings.