Effects of Arbiturary Acute Anticonvulsnat Withdrawal in Epileptic Children

Lim, Keun Hee; Lee, Eun Sil; Moon, Han Ku

Abstract

PURPOSE: The effects of arbiturary acute anticonvulsants withdrawal in epileptic children were studied and relationship between status epilepticus and anticonvulsant withdrawal was analysed.
METHODS
Medical records of 88 withdrawal episodes in 72 active epileptic children were analysed retrospectively according to the types of epilepsies, anticonvulsants.
RESULTS
1) When followed up after withdrawal, 42 cases (47.7%) had a recurrence of habitual seizure, 18 cases (20.5%) had no seizure and increased seizure frequency were found in 14 cases (16.0%). Three cases (3.4%) had no change in seizure frequency or severity and in 2 cases (2.3%) the frequency or severity of seizure were decreased after withdrawal. 2) Recurrence of habitual seizure, increased seizure frequency, more intense seizure or status epilepticus were noted in 55 of 71 withdrawal episodes in focal epilepsies (77.5%), in 9 of 17 withdrawal episodes (52.9%) in generalized epilepsies (P=0.041). These changes occurred in 36 of 55 cases (65.5%) in focal epilepsies, 3 of 9 cases (30.0%) in generalized epilepsies within 4 weeks after withdrawal (P=0.137). 3) Recurrence of habitual seizure, increased seizure frequency, development of more intense seizure or status epilepticus were found in 18 of 26 cases (69.2%) in carbamazepine monotherapy, 15 of 16 cases (93.8%) in phenobarbital monotherapy, 24 of 34 cases (70.6%) in polypharmacy (P=0.143). These changes occurred in 14 of 18 cases (77.8%) in carbamazepine monotherapy, 7 of 15 cases (46.7%) in phenobarbital monotherapy and 18 of 24 cases (75.0%) in polypharmacy within 4 weeks after withdrawal (P=0.122). 4) Four cases (4.5%) of status epilepticus occurred in 4 patients with focal epilepsies at 4 months (2 cases), 5 months, 23 months later after acute anticonvulsant withdrawal.
CONCLUSION
Arbiturary acute anticonvulsants withdrawal in epileptic children were more common than expectation and councelling to avoid arbiturary anticonvulsant withdrawal must be entensified. Approximately half of the cases with anticonvulsant withdrawal showed a recurrence of habitual seizure and status epilepticus occurred in 4.5% of cases only. Other factors besides acute anticonvulsant withdrawal must be investigated to clarify the underlying mechanism of status epilepticus. A quarter of cases showed no seizure and even decrease in seizure frequency or severity after anticonvulsant withdrawal. These results suggest more considerated prescription of anticonvulsant is needed in practice.