The Course of Children with Epilepsy Who Discontinued Treatment 2–3 Years After Their Last Seizure

Purpose : Anticonvulsant drugs (AEDs) have potential side effects, and therefore, discontinuation of administration at an early stage is preferable. The general policy for treatment in Japan depends greatly on the electroencephalographic (EEG) findings. In Europe and America, however, the general policy is to discontinue treatment if no epileptic seizures have occured within 2 years. We followed the latter policy, and in cases of intractable seizures, the medication was discontinued 3 years after the cessation of seizures. Some cases in which the medication was discontinued within 2 years after cessation of the seizures were also included in this report. The risk factors were examined as indicated later. Methods : Between 1985 and 1996, the administration of AEDs was discontinued in 113 cases according to the aforementioned policy. After exclusion of six cases who could not be followed up and 15 cases who were observed for < 1 year after the discontinuation of medication, 92 patients were examined. The mean follow‐up period for the subjects who had no recurrence of seizures was 4.7 years (range, 1–10.5 years). The age when the first seizure occurred was younger than 1 year in 13 cases, 1–5 years in 42 cases, 6–12 years in 26 cases, and 13 years or older in six cases. Annual investigations were carried out either by telephone or mail since 1993. The results collected by December 1996 were analyzed. Kaplan‐Meier's method and the 2 test were used for statistical analysis. Results : Discontinuation of administration was performed 100 times in the 92 cases, and recurrence of seizures occurred 20 times. Seven recurrent cases underwent discontinuation repeatedly (a total of eight times) with successful results. The significant risk factors were symptomatic epilepsy, cryptogenic epilepsy, and age at the onset of seizures of 2 12 years. Sex, EEG abnormalities, general/focal convulsions, febrile convulsions, duration between seizures of >3 years, 3 12 years of age at last seizure, status epilepticus, family history of epilepsy, and seizures during sleep were not considered risk factors. Regarding idiopathic epilepsy, there were no significant differences among the groups treated for <2 years, 2 years, or 3 years. Conclusions : The risk factors were symptomatic epilepsy, cryptogenic epilepsy, and age at the onset of seizures of 312 years. In cases having such risk factors, drug discontinuation when recurrence has not occurred for 3 years is advisable. In children with idiopathic epilepsy, the policy of drug discontinuation when recurrence has not been observed for 2 years is fully acceptable, and further extension of the treatment period appears unnecessary. Even 1 year of absence of seizures may he sufficient for discontinuation of medication. Because EEG abnormalities are not considered risk factors, prognosis based on EEG observations should be abandoned.