A recent study developed and externally validated a predictive model to assess the risk of seizure recurrence following the discontinuation of antiseizure medication in children with epilepsy.
Kunyu Dai, MD, and colleagues developed a predictive model identifying nine independent risk factors for seizure relapse. The model is intended to assist clinicians in making individualized decisions regarding antiseizure medication (ASM) withdrawal in pediatric patients.
Published in eClinicalMedicine, the study synthesized data from 26 cohort studies comprising 4,080 pediatric patients with epilepsy; 959 (23.5%) experienced seizure recurrence after ASM withdrawal. The model was developed using a systematic review and meta-analysis of cohort studies and was prospectively validated in a clinical cohort of pediatric patients from Children’s Hospital of Chongqing Medical University and Kunming Children’s Hospital in China.
The nine risk factors identified as significantly associated with seizure recurrence were: intellectual disability; abnormal neurologic examination or motor deficit; history of febrile seizures; only focal onset seizures; use of 2 or more ASMs; duration of epilepsy of 3 years or more; abnormal electroencephalogram (EEG) at the start of ASM tapering; abnormal EEG after ASM tapering; and age at first seizure of 10 years or older.
Each risk factor was assigned a weighted score, yielding a maximum possible total risk score of 17. In the prospective validation cohort of 341 patients (median follow-up, 2.84 years), 122 (35.8%) experienced seizure relapse. The model demonstrated strong discriminatory performance, with an area under the receiver operating characteristic curve of 0.85, sensitivity of 0.74, and specificity of 0.82.
“Our evidence-based predictive model offers a robust tool for estimating the risk of seizure recurrence in pediatric patients with epilepsy after ASM withdrawal,” said Kunyu Dai, from the Department of Rehabilitation, Children’s Hospital of Chongqing Medical University, China. The authors emphasized the importance of individualized treatment planning and noted that the model’s predictive thresholds require external validation across diverse clinical settings and populations.
Among a subset of 526 patients for whom the timing of seizure recurrence was available, 437 (83.1%) experienced relapse within the first two years after ASM withdrawal. This finding underscores the importance of carefully evaluating risk factors before initiating medication tapering in children who have remained seizure-free for at least two years.
The authors reported that the model is primarily applicable to pediatric populations in Western and Asian regions, reflecting the demographics of the included studies. The research was conducted collaboratively across several institutions in China and was supported by the Chongqing Medical University Program for Youth Innovation in Future Medicine. The authors reported no conflicts of interest. They recommended future longitudinal studies to assess the model’s long-term predictive accuracy and to explore additional variables that may influence its clinical utility over time.