Analysis of risk factors for relapse of 133 epileptic children after withdrawal of drugs_Journal of Epilepsy

Authors：

XIAO Yanli ^1,2 , XU Xuena ^1,2 , YONG ZengHua ² , GAO Yuchen ² , DOU Yunlong ² ,  YUAN Baoqiang ²

1. Department of Clinical Medicine, Graduate School, Xuzhou Medical University, Xuzhou 221002, China;
2. Department of Children's Neurology and Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China;

Corresponding author：

YUAN Baoqiang, Email: 475154304@qq.com

Keywords：

Epilepsy; Withdrawal; Recurrence; Risk factors

DOI：

10.7507/2096-0247.20200034

Video：

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Objective The risk factors of relapse in 133 epileptic children after withdrawal were analyzed retrospectively and provide reference for clinical withdrawal.Methods From January 2017 to March 2019, 133 children with withdrawal epilepsy were selected as the study object. According to whether there was recurrence during the follow-up period, the children with epilepsy were divided into recurrence group (42 cases) and non recurrence group (91 cases). The gender, age of onset, history of trauma, frequency of seizure before treatment, EEG before drug reduction, imaging, type of medication, family history, time of reaching control, course of disease before treatment, comorbidity, multiple attack types, withdrawal speed and EEG before treatment were observed and compared between the two groups. Results There were significant differences in EEG (χ² =7.621), medication type (χ²=8.760), time to control (χ²=6.618), course before treatment (χ²=6.435), multiple seizure types (χ²=5.443) and epilepsy comorbidity (χ²=42.795) between the two groups (P < 0.05). The results of Logistic multiple regression analysis showed that the recurrence of epileptic children after drug reduction / withdrawal was correlated with abnormal EEG before drug reduction [OR=9.268, 95%CI (2.255, 38.092)], combined drug treatment [OR=3.205, 95%CI (1.159, 8.866)] and course of disease > 1 year before treatment [OR=5.363, 95%CI (1.781, 16.150)] (P < 0.05).Conclusions In order to reduce the possibility of recurrence of epileptic children, the treatment time of epileptic children with abnormal EEG, combined medication and long course before treatment should be prolonged properly.

Citation： XIAO Yanli, XU Xuena, YONG ZengHua, GAO Yuchen, DOU Yunlong, YUAN Baoqiang. Analysis of risk factors for relapse of 133 epileptic children after withdrawal of drugs. Journal of Epilepsy, 2020, 6(3): 193-198. doi: 10.7507/2096-0247.20200034 Copy

1.	季涛云, 姜玉武. 2018 年儿童癫痫治疗进展. 中华医学信息导报, 2019, 34(6): 17-18.
2.	Fiest KM, Sauro KM, Wiebe S, et al. Prevalence and incidence of epilepsy. Neurology, 2017, 88(3): 296-303.
3.	Moosa ANV. Antiepileptic Drug Treatment of Epilepsy in Children. CONTINUUM Lifelong Learning in Neurology, 2019, 25(2): 381-407.
4.	Sankaraneni, R am, Lachhwani, et al. Antiepileptic drugs—a review. Pediatric Annals, 2015, 44(2): e36-e42.
5.	王萍, 虞培敏, 洪震. 使用抗癫痫药患者的撤药问题. 上海医药, 2015, (9): 16-20, 24.
6.	Falco-Walter, Jessica JF, Robert S, et al. The new definition and classification of seizures and epilepsy. Epilepsy Research, 2018, 139(1): 73-79.
7.	Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia, 2010, 51(4): 676-685.
8.	Verrotti A, D' Egidio C, Agostinelli S, et al. Antiepileptic drug withdrawal in childhood epilepsy: what are the risk factors associated with seizure relapse? EJPN, 2012, 16(6): 599-604.
9.	胡文静, 廖红梅, 唐静文, 等. 癫痫患儿撤药后复发的相关因素. 中华实用儿科临床杂志, 2014, 29(24): 1862-1865.
10.	Olmez Akgun, Arslan Umut, Turanli Guzide, et al. Risk of recurrence after drug withdrawal in childhood epilepsy. Seizure, 2009, 18(4): 251-256.
11.	陈晓轶, 朱永杰, 陈国洪, 等. 癫痫患儿停药后复发危险因素分析. 中国继续医学教育, 2016, 8(4): 80-81.
12.	郭改艳, 刘胜武. 儿童癫痫患者停药后复发的高危因素研究. 中国实用神经疾病杂志, 2016, 19(8): 47-49.
13.	Beghi E, Giussani G, Grosso S, et al. Withdrawal of antiepileptic drugs: Guidelines of the Italian League Against Epilepsy. Epilepsia, 2013, 54(7): 2-12.
14.	Shih Jerry J, Ochoa Juan G. A systematic review of antiepileptic drug initiation and withdrawal. Neurologist, 2009, 15(3): 122-131.
15.	Lee Inn-Chi, Li Shuan-Yow, Chen Yung-Jung. Seizure Recurrence in Children after stopping antiepileptic medication: 5-year follow-up. Pediatr Neonatol, 2017, 58(4): 338-343.
16.	Berg AT, Shinnar S. Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology, 1994, 44(4): 601.
17.	Lossius Morten Ingvar, Hessen Erik, Mowinckel Petter, et al. Consequences of antiepileptic drug withdrawal: a randomized, double-blind study (Akershus Study). Epilepsia, 2008, 49(3): 455-463.
18.	慕鹏莺. 癫痫患者撤药后癫痫复发的影响因素分析. 海南医学, 2016, 27(14): 2351-2352.
19.	Tang L, Xiao Z. Can electroencephalograms provide guidance for the withdrawal of antiepileptic drugs: a meta-analysis. Clinical Neurophysiology, 2017, 128(2): 297-302.
20.	Yao J, Wang H, Xiao Z. Correlation between EEG during AED withdrawal and epilepsy recurrence: a meta-analysis. Neurological Sciences, 2019, 40(8): 1637-1644.
21.	Chen T, Si Y, Chen D, et al. The value of 24-hour video-EEG in evaluating recurrence risk following a first unprovoked seizure: a prospective study. Seizure, 2016, 40: 46-51.
22.	Ou Shuchun, Xia Lu, Li Rong, et al. Long-term outcome of seizure-free patients and risk factors of relapse following antiepileptic drug withdrawal. Epilepsy Behav, 2018, 88: 295-300.
23.	Ohta H, Ohtsuka Y, Tsuda T, et al. Prognosis after withdrawal of antiepileptic drugs in childhood-onset cryptogenic localization-related epilepsies. Brain & Development, 2004, 26(1): 19-25.
24.	Kalita J, Vajpeyee A, Misra UK. Predictors of one-year seizure remission--a clinicoradiological and electroencephalographic study. Electromyogr Clin Neurophysiol, 2005, 45(3): 161-166.
25.	许飞, 孙红斌. 单药治疗癫痫患者停药后复发的高危因素研究. 中华神经医学杂志, 2014, 13(10): 1053-1055.
26.	田显忠. 即刻和延迟治疗对新诊断癫痫患者复发的影响. 医学理论与实践, 2015, 4(19): 2625-2626.
27.	Su L, Di Q, Kwan P, et al. Prediction for relapse and prognosis of newly diagnosed epilepsy. Acta Neurologica Scandinavica, 2013, 127(2): 141-147.
28.	郁兆勇. 探讨不同治疗时机对新诊断癫痫患者复发和预后的影响. 医药前沿, 2012, 8(22): 209.
29.	Ramos-Lizana J, J. Aguirre-Rodríguez, P. Aguilera-López, et al Recurrence risk after withdrawal of antiepileptic drugs in children with epilepsy: A prospective stud. European Journal of Paediatric Neurology, 2010, 14(2): 116-124.
30.	张赟, 郑辑英, 李光来, 等. 癫痫发病机制研究的进展与脑损伤机制. 中华临床医师杂志(电子版), 2016, 10(8): 1168-1171.
31.	Hawash KY, Rosman NP. Do partial seizures predict an increased risk of seizure recurrence after antiepilepsy drugs are withdrawn? Journal of Child Neurology, 2003, 18(5): 331-337.

1. 季涛云, 姜玉武. 2018 年儿童癫痫治疗进展. 中华医学信息导报, 2019, 34(6): 17-18.
2. Fiest KM, Sauro KM, Wiebe S, et al. Prevalence and incidence of epilepsy. Neurology, 2017, 88(3): 296-303.
3. Moosa ANV. Antiepileptic Drug Treatment of Epilepsy in Children. CONTINUUM Lifelong Learning in Neurology, 2019, 25(2): 381-407.
4. Sankaraneni, R am, Lachhwani, et al. Antiepileptic drugs—a review. Pediatric Annals, 2015, 44(2): e36-e42.
5. 王萍, 虞培敏, 洪震. 使用抗癫痫药患者的撤药问题. 上海医药, 2015, (9): 16-20, 24.
6. Falco-Walter, Jessica JF, Robert S, et al. The new definition and classification of seizures and epilepsy. Epilepsy Research, 2018, 139(1): 73-79.
7. Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia, 2010, 51(4): 676-685.
8. Verrotti A, D' Egidio C, Agostinelli S, et al. Antiepileptic drug withdrawal in childhood epilepsy: what are the risk factors associated with seizure relapse? EJPN, 2012, 16(6): 599-604.
9. 胡文静, 廖红梅, 唐静文, 等. 癫痫患儿撤药后复发的相关因素. 中华实用儿科临床杂志, 2014, 29(24): 1862-1865.
10. Olmez Akgun, Arslan Umut, Turanli Guzide, et al. Risk of recurrence after drug withdrawal in childhood epilepsy. Seizure, 2009, 18(4): 251-256.
11. 陈晓轶, 朱永杰, 陈国洪, 等. 癫痫患儿停药后复发危险因素分析. 中国继续医学教育, 2016, 8(4): 80-81.
12. 郭改艳, 刘胜武. 儿童癫痫患者停药后复发的高危因素研究. 中国实用神经疾病杂志, 2016, 19(8): 47-49.
13. Beghi E, Giussani G, Grosso S, et al. Withdrawal of antiepileptic drugs: Guidelines of the Italian League Against Epilepsy. Epilepsia, 2013, 54(7): 2-12.
14. Shih Jerry J, Ochoa Juan G. A systematic review of antiepileptic drug initiation and withdrawal. Neurologist, 2009, 15(3): 122-131.
15. Lee Inn-Chi, Li Shuan-Yow, Chen Yung-Jung. Seizure Recurrence in Children after stopping antiepileptic medication: 5-year follow-up. Pediatr Neonatol, 2017, 58(4): 338-343.
16. Berg AT, Shinnar S. Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology, 1994, 44(4): 601.
17. Lossius Morten Ingvar, Hessen Erik, Mowinckel Petter, et al. Consequences of antiepileptic drug withdrawal: a randomized, double-blind study (Akershus Study). Epilepsia, 2008, 49(3): 455-463.
18. 慕鹏莺. 癫痫患者撤药后癫痫复发的影响因素分析. 海南医学, 2016, 27(14): 2351-2352.
19. Tang L, Xiao Z. Can electroencephalograms provide guidance for the withdrawal of antiepileptic drugs: a meta-analysis. Clinical Neurophysiology, 2017, 128(2): 297-302.
20. Yao J, Wang H, Xiao Z. Correlation between EEG during AED withdrawal and epilepsy recurrence: a meta-analysis. Neurological Sciences, 2019, 40(8): 1637-1644.
21. Chen T, Si Y, Chen D, et al. The value of 24-hour video-EEG in evaluating recurrence risk following a first unprovoked seizure: a prospective study. Seizure, 2016, 40: 46-51.
22. Ou Shuchun, Xia Lu, Li Rong, et al. Long-term outcome of seizure-free patients and risk factors of relapse following antiepileptic drug withdrawal. Epilepsy Behav, 2018, 88: 295-300.
23. Ohta H, Ohtsuka Y, Tsuda T, et al. Prognosis after withdrawal of antiepileptic drugs in childhood-onset cryptogenic localization-related epilepsies. Brain & Development, 2004, 26(1): 19-25.
24. Kalita J, Vajpeyee A, Misra UK. Predictors of one-year seizure remission--a clinicoradiological and electroencephalographic study. Electromyogr Clin Neurophysiol, 2005, 45(3): 161-166.
25. 许飞, 孙红斌. 单药治疗癫痫患者停药后复发的高危因素研究. 中华神经医学杂志, 2014, 13(10): 1053-1055.
26. 田显忠. 即刻和延迟治疗对新诊断癫痫患者复发的影响. 医学理论与实践, 2015, 4(19): 2625-2626.
27. Su L, Di Q, Kwan P, et al. Prediction for relapse and prognosis of newly diagnosed epilepsy. Acta Neurologica Scandinavica, 2013, 127(2): 141-147.
28. 郁兆勇. 探讨不同治疗时机对新诊断癫痫患者复发和预后的影响. 医药前沿, 2012, 8(22): 209.
29. Ramos-Lizana J, J. Aguirre-Rodríguez, P. Aguilera-López, et al Recurrence risk after withdrawal of antiepileptic drugs in children with epilepsy: A prospective stud. European Journal of Paediatric Neurology, 2010, 14(2): 116-124.
30. 张赟, 郑辑英, 李光来, 等. 癫痫发病机制研究的进展与脑损伤机制. 中华临床医师杂志(电子版), 2016, 10(8): 1168-1171.
31. Hawash KY, Rosman NP. Do partial seizures predict an increased risk of seizure recurrence after antiepilepsy drugs are withdrawn? Journal of Child Neurology, 2003, 18(5): 331-337.

Journal of Epilepsy

Analysis of risk factors for relapse of 133 epileptic children after withdrawal of drugs

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