Duration of active epilepsy as a predictor of seizure control after relapse in child epilepsy
Abstract
Background Epilepsy is a chronic illness that may affect childhood growth and development. Some epilepsy cases are easy to control, either with monotherapy or politherapy antiepilepticdrugs, but many cases are difficult to control. Several factors influence the risk of relapse, but information is limited on factors predictive of seizure control after relapse. Our study investigate patient with epilepsy relaps and see whether the duration of active epilepsy prior to initial remission can be use as a predictor of seizure control after relaps.
Objective To assess whether duration of active epilepsy was predictive of seizure control after relapse.
Methods This retrospective cohort study was performed in Dr Sardjito Hospital, Yogyakarta, on epileptic relapse patients aged 2 to 18 years , who had achieved remission for at least a 2-year seizure-free interval, and relapsed after antiepileptic drud (AED) discontinuation. We excluded patients with progressive neurological diseases, inborn errors of metabolism, febrile seizures, and those who could not be followed up for at least 2 years, or those with incomplete medical records. Subjects were divided into those who had a duration of active epilepsy prior to initial remission within 6 months and ≥6 months. Time to seizure control after relapse was analysed by Kaplan-Meier survival analysis.
Results A total of 80 patients were included in the study. Overall median for seizure control after relapse was 3.6 (95%CI 1.1 to 6.0) months. Median for seizure control after relapse for those who had a duration of active epilepsy prior to initial remission within 6 months and >= 6 months were 3 (95%CI 0.1 to 5.8) months and 12 (95%CI 4.4 to 19.5) months, respectively. Log-rank test revealed no significant difference between groups (P=0.12).
Conclusion Duration of active epilepsy prior to initial remission was not a predictor for seizure control after relapse.
References
2. Reynolds EH. The ILAE/IBE/WHO Global Campaign against Epilepsy: Bringing epilepsy “out of the shadows.” Epilepsy Behav. 2000;1:S3-8. DOI: 10.1006/ebeh.2000.0104.
3. Mangunatmadja I, Handryastuti S, Amalia Risan N. Epilepsi pada anak. Badan Penerbit Ikatan Dokter Anak Indonesia; 2016. p. 1-3, 41-3.
4. Browne T, GL H. Hand book of epilepsy. In: McMillan L, editor. 4th ed. Philadelphia: Lippincot Williams & Wilkins; 2008. p. 1, 200-2.
5. Strozzi I, Nolan SJ, Sperling MR, Wingerchuk DM, Sirven J. Early versus late antiepileptic drug withdrawal for people with epilepsy in remission. Cochrane Database of Systematic Reviews. 2015;CD001902. DOI: 10.1002/14651858.CD001902.pub2.
6. Berg a T, Shinnar S. Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology. 1994;44:601–8. DOI: 10.1212/wnl.44.4.601.
7. Callaghan B, Schlesinger M, Rodemer W, Pollard J, Hesdorffer D, Allen Hauser W, et al. Remission and relapse in a drug-resistant epilepsy population followed prospectively. Epilepsia. 2011;52:619–26. DOI: 0.1111/j.1528-1167.2010.02929.x.
8. Specchio LM, Beghi E. Should antiepileptic drugs be withdrawn in seizure-free patients? Vol. 18, CNS Drugs. 2004. p. 201–12. DOI: 10.2165/00023210-200418040-00001.
9. Olmez A, Arslan U, Turanli G, Aysun S. Risk of recurrence after drug withdrawal in childhood epilepsy. Seizure. 2009;18:251–6. DOI: 0.1016/j.seizure.2008.10.011.
10. Triono A. Naskah lengkap, Ujian terbuka?:Predictors of Relapse and Outcomes in Children with Controlled Epilepsy and After Antiepileptic Drug Withdrawal: Case Control Study. [Jakarta]: Fakultas kedokteran Universitas Indonesia; 2017.
11. Arts WF, Visser LH, Loonen MC, Tjiam AT, Stroink H, Stuurman PM, et al. Follow-up of 146 children with epilepsy after withdrawal of antiepileptic therapy. Epilepsia. 1988;29:244–50.
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Accepted 2020-07-17
Published 2020-07-17
