A Cochrane review [Abstract] 1 included 5 studies with a total of 924 pediatric epilepsy patients. All were under 16 years of age at randomisation, with a median follow-up of 5.6 years. Included studies compared an early versus late antiepileptic drug (AED) discontinuation.The pooled risk ratio (RR) for seizure relapse after AED withdrawal was 1.34 (95% CI 1.13 to 1.59, p=0.0007; 5 studies, n=924). The number needed to harm, that is to expose an individual to a higher risk of seizure relapse because of early withdrawal of AED, is 8 (95% CI 5 to 20; 5 trials, n=924). Early discontinuation was associated with greater relapse rates in patients with partial seizures (RR 1.51, 95% CI 0.97 to 2.35, p=0.07; 2 trials, n=180). Absence type epilepsy showed a lower risk of relapse. Variables associated with higher risk of seizure relapse were abnormal EEG findings (pooled RR 1.44, 95% CI 1.13 to 1.83, p=0.003; 2 studies, n=618), especially epileptiform activity (RR 2.58, 95% CI 2.03 to 3.28, p< 0.0001; one study, n=433); epilepsy onset before 2 years or after 10 years of age; history of status epilepticus; intellectual disability (IQ < 70); and high seizure frequency before and during treatment. Gender and family history did not show any significant influence over seizure relapse.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment).
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