Risk Factors For Seizure Recurrence After Antiepileptic Drug Withdrawal in Children with Idiopathic Epilepy

Öz

Objective: The purpose of this study is to evaluate the risk factors on seizure recurrence after antiepileptic drug withdrawal in children with idiopathic epilepsy.

Material and Methods: The treatment is withdrawn within 4-6 months in all patients who had normal magnetic resonance imaging and electroencephalogram results on at least 24 months of antiepileptic drug treatment. After drug withdrawal 72 patients had seizure recurrence in whom labeled as relapse group. Eighty-two patients had no seizure recurrence are labeled as remission group.

Results: The age of diagnosis with epilepsy and remission time were observed as risk factors on seizure recurrence. It is determined that after drug withdrawal seizure recurrence is occurred within the first 2 years of follow-up in 95,9 % of the relapse group’s patients.

Conclusion: In patients, who had more than 3 months of seizure remission time have more seizure recurrence risk after drug withdrawal. Furthermore, it is observed that in patients older than 12 years old the risk of recurrence

Anahtar Kelimeler

• Epilepsy
• Seizure
• Drug withdrawal

İdiyopatik Epilepsi Tanılı Çocuk Hastalarda Antiepileptik Tedavi Kesimi Sonrası Nöbet Tekrarı ile İlişkili Risk Faktörleri

Öz

Amaç: Bu çalışmanın amacı idiyopatik epilepsi tanılı çocuklarda anti epileptik tedavi kesimi sonrası nöbet tekrarına etki eden risk faktörlerini değerlendirmektir.

Gereç ve Yöntem: En az 24 ay anti epileptik tedavi alan, kraniyal manyetik rezonans görüntüleme ve elektroensefalografi sonuçları normal olan hastaların ilaç tedavisi 4-6 aylık süreçte azaltılarak kesilmiştir. Tedavi kesimi sonrası nöbeti tekrarlayan 72 hasta relaps grubunu, nöbeti tekrar etmeyen 82 hasta ise remisyon grubunu oluşturmuştur.

Sonuç: Hastaların tanı yaşı ve tedavi başlanması sonrasında nöbet kontrol sürelerinin relaps üzerine etki eden risk faktörleri olduğu görülmüştür. Relaps grubundaki hastaların %95,9’unda nöbet tekrarının ilk 2 yıl içerisinde geliştiği belirlenmiştir.

Tartışma: Tedavi başlanmasından sonra nöbet kontrol süresi 3 ay ve üzerinde olan hastalarda ilaç kesim sonrası tekrarlama riski daha yüksektir. Ayrıca epilepsi tanı yaşı 12 ve üzerinde olan hastalarda da tekrarlama riskinin yüksek olduğu görülmüştür. Bununla birlikte anti epileptik tedavisi kesilen tüm hastalarda 2 yıl yakın takip önermekteyiz.

Anahtar Kelimeler

• Epilepsi
• Nöbet tekrarı
• Tedavi kesimi

Kaynakça

1. Referans1 Swaiman KS, Ashwal S, Ferriero DM. Pediatric Neurology Principles and Practice. New York: Mosby Press 2005:989-1181.
2. Referans2 Shinnar S, Berg AT, Moshe SL, Kang H, O’dell CRN, Alemany M, et al. Discontinuing antiepileptic drugs in children with epilepsy: a prospective study. Ann Neurol 1994;35:534-45.
3. Referans3 Ramoz-lizana J, Aguirre-Rodriguez J, Aguilera-Lopez P, Cassinello-Garcia E. Recurrence risk after withdrawal of antiepileptic drugs in children with epilepsy: A prospective study. European J pediatric neurology 2010;14:116-24.
4. Referans4 Silliapaa M, Schmidt D. Prognosis of seizure recurrence after stopping antiepileptic drugs in seizure-free patients: a long term population –based study of childhood onset epilepsy. Epilepy&behavio r2006;8:713-19.
5. Referans5 Commission on Classification and Terminology of the international League Aganist Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989;30:389-99.
6. Referans6 Callaghan N, Garret A, Goggin T. Withdrawal of anticonvulsant drugs in patients free of scziures for two years: A prospective study. N Engl J Med 1988;318:942-46.
7. Referans7 Ölmez A, Arslan U, Turanlı G, Aysun S. Risk of recurrence after drug withdrawal in childhood epilepsy. Seizure 2009;18:251-56.
8. Referans8 Verrotti A, Trotta D, Salladini C, Morgese G, Chiarelli F. Risk factors fo rrecurrence of epilepsy and withdrawal of antiepileptic therapy: a practical approach. AnnMed 2013;35:207–15.

9. Referans9 Tang X, Yu P, Ding D, Ge Y, Shi Y, Wang P, et al. Risk factors for seizure reoccurrence after withdrawal from antiepileptic drugs in individuals who have been seizure-free for over 2 years. PLoSOne 2017;12(8):e0181710.
10. Referans10 Karalok ZS, Guven A, Öztürk Z, Gürkaş E. Risk Factors for Recurrence after Withdrawal in Childhood Epilepsy. Brain Dev 2019 https://doi.org/10.1016/j.braindev.2019.08.012
11. Referans11 So NK. Recurrence, remission, and relapse of seizures. Cleveland ClinicJournal of Medicine 1993;60:439-44.
12. Referans12 Kudo T, Nishida T, Yagi K. Discontinuation and duration of antiepileptic drug therapy: a retrospective study of factors for specific epileptic syndromes. Epilepsia 2004;45:26-32.
13. Referans13 Morteni IL, StavemK, Gjerstad L. Predictors for recurrence of epileptic seizures in a general epilepsy population. Seizure 1999;8:476-79.
14. Referans14 Çeleğen M, Yılmaz Ü, Gürbüz G, Çeleğen K, Ünalp A. Antiepileptik Tedavinin Kesilmesinden Sonra Nöbet Yinelemesini Etkileyen Risk Faktörlerinin Değerlendirilmesi. İzmir Dr. Behçet Uz Çocuk Hast. Dergisi 2015;5:109-14.
15. Referans15 Pavlovic M, Jovic N a, Pekmezovic T. Antiepileptic drugs withdrawal in patients with idiopathic generalized epilepsy. Seizure 2011;20:520-25.
16. Referans16 S. Shinnar. Update on the epidemiology and prognosis of pediatric epilepsy. J Child Neurol2002;17:4-17.
17. Referans17 V. Gross-Tsur, S. Shinnar. Discontinuing antiepileptic drug treatment. 2nd ed. Williams and Wilkins, Baltimore, MD 1996:799-807.
18. Referans18 Beghi E, Giussani G, Grosso S, Iudice A, La Neve A, Pisani F, et al. Withdrawal of antiepileptic drugs: guidelines of the Italian League Against Epilepsy. Epilepsia 2013;54:2–12.
19. Referans19 ArtsWhm, VisserLh, LoonenMcb, Tjiam At, Stroink H, Stuurman Pm et al. Follow up 146 childeren with epilepsy after withdrawal of antiepileptic therapy. Epilepsia 1998;29:244-50.
20. Referans20 Martinez-Juarez IE, Alonso ME, Medina MT, Duro´n RD, Bailey JN, Lo´pez-Ruiz M, et al. Juvenile myoclonic epilepsy subsyndromes: family studies and long-termfollow-up. Brain 2006;129:269-280.