Serum lipid profile in children receiving anti-epileptic drug monotherapy: is it atherogenic?

The effect of anti-epileptic drugs (AEDs) on serum lipid profile is controversial in children as well as in adults. We longitudinally studied serum lipid profile in 34 newly diagnosed epileptic children receiving AED monotherapy with valproic acid (VPA), carbamazepine (CBZ) or phenobarbital (PB). Serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), apolipoprotein Al (Apo A1) and apolipoprotein B (Apo B) were measured at baseline and after 2 years of AED monotherapy. Atherosclerotic indices of TC/ HDL-C and Apo A1/Apo B ratios were calculated. Although there were some alterations in serum lipid profile with AED without statistical significance, the atherosclerotic indices of TC/HDL-C and Apo A1/Apo B ratios did not change significantly after 2 years of monotherapy. Only serum TGs levels significantly decreased with VPA monotherapy. These data suggest that 2 years AED monotherapy with VPA, CBZ or PB did not cause a significant level of concern for an atherogenic effect in children with epilepsy.     

Thyroid function and volume in epileptic children using carbamazepine, oxcarbazepine and valproate

BACKGROUND: The aim of the present study was to investigate the effects of carbamazepine (CBZ), oxcarbazepine (OXC), and valproic acid (VPA) on thyroid function and volume in epileptic children. METHODS: Fifty-three epileptic children (age, 3-17 years) treated with OXC (n = 10), CBZ (n = 12), or VPA (n = 31) at least for 1 year were evaluated in terms of thyroid hormones, thyroid-stimulating hormone (TSH) levels, response to thyrotropin-releasing hormone (TRH) stimulation test, and thyroid volumes. RESULTS: The patients in the OXC and CBZ groups had similar total thyroxin (TT4) and free T4 (fT4) median levels that were significantly lower than those of the VPA group (P < 0.016). Total tri-iodothyrosin median levels were lower in the CBZ group compared to the VPA group (P < 0.016). Basal TSH levels and thyroid volumes were similar in all groups (P > 0.016). One child from the OXC group (10%), one from the CBZ group (%8.3), and six from the VPA group (19.3%) had hypothyroidic status according to the TRH stimulation test. No statistically significant correlations were found between thyroid gland volume and thyroid function variables and between anti-epileptic drug receiving time and thyroid function or thyroid volume, respectively, in any of the groups (P > 0.05). CONCLUSIONS: Thyroid function should be evaluated periodically in children using CBZ, OXC or VPA. The children taking VPA seems to be at greater risk compared to children onr CBZ or OXC therapy. Except for the basal TSH values in the VPA group, the parameters predictive for the subclinical hypothyroid status remain to be evaluated in further studies.     

Antiepileptic drug-induced osteopenia in ambulatory epileptic children receiving a standard vitamin D3 supplement

Dual energy X-ray absorptiometry (DEXA) is a non-invasive, rapid, accurate and highly reproducible method for the assessment of antiepileptic drug (AED)-induced osteopenia in epileptic children. In this study, we investigated bone mineral density (BMD) using DEXA in 56 epileptic children receiving long-term AED treatment for at least 2 years. All children received AED monotherapy or polytherapy plus a standard vitamin D3 supplement (400 U/day). BMD measurements were made from lumbar spine (L2-L4) regions. Age- and sex-specific BMD SD scores were calculated for each child. Osteopenia was defined as SD scores less than -1.5. There was no significant difference in mean BMD values between epileptic children receiving monotherapy or polytherapy. The results were also compared to the age- and sex-specific BMD SD scores obtained from healthy Turkish children. Only three patients (5%) receiving AED therapy had a BMD SD score less than -1.5. This rate is relatively lower than the rates of previous studies conducted on ambulatory children on long-term AED treatment without vitamin D3 supplementation.     

The effects of antiepileptic drugs on the relationships between leptin levels and bone turnover in prepubertal children with epilepsy

Antiepileptic drugs (AED) had an effect on bone metabolism in children. This study was conducted in order to determine the relationships between serum leptin levels, bone mineral density (BMD) and bone turnover markers in epileptic children. Fifty-three patients were treated with valproic acid (VPA) and 23 with carbamazepine (CBZ) monotherapy; 50 healthy children were included in the study as controls. Serum alkaline phosphatase (ALP) and cross-linked C-telopeptide (CTx) levels were statistically significantly higher in the CBZ group than in the VPA group and the control group (p < 0.0001, p < 0.010, respectively). Serum osteocalcin and ALP levels were significantly lower in the VPA group than in the control group (P < 0.012, P < 0.030, respectively). Although we found slightly higher serum leptin levels in both the CBZ and VPA groups, they were not significantly different from the control group (P > 0.05). We demonstrated that the markers of bone formation and resorption increased with CBZ and decreased with VPA treatment without affecting BMD and vitamin D levels in prepubertal epileptic children.     

卡马西平和丙戊酸钠对癫癎患儿骨代谢的影响

目的探讨长期服用卡马西平（CBZ）或丙戊酸钠（VPA）对癫痫患儿骨代谢的影响。方法对92名单独服用CBZ或VPA2年以上的癫痫患儿及35名年龄匹配的健康儿童的骨密度进行测量,测定骨代谢特异性生化指标,血清骨钙素（OC,骨形成指标）和尿脱氧吡啶酚（DPD,骨吸收指标）,并调查每日钙摄入量。结果癫痫患儿骨密度明显低于对照组（P〈0．05）,服用抗癫痫药物（AEDs）的时间与骨密度呈负相关（rs=-0．21～-0．31,P〈0．05）。癫痫患儿中低骨密度患儿32人,占35％,明显高于对照组14％（P〈0．05）。低骨密度的癫痫患儿多体重指数较高（P〈0．05）,每日钙摄入量较少（P〈0．01）,服用AEDs的时间相对较长（P〈0．01）。癫痫患儿血清OC浓度明显低于对照组（P〈0．01）;而尿DPD浓度与对照组基本一致（P〉0．05）。结论长期服用CBZ或VPA会导致骨代谢异常,骨密度下降、骨转换降低（以骨形成减少为主）;而钙摄入量不足及体重指数偏高是加剧骨骼异常的诱发因素。     

托吡酯对癫(癎)患儿骨代谢的影响

目的探讨抗癫癇药托吡酯(topiramate,TPM)对癫癇患儿骨代谢的影响。方法对单独服用托吡酯组32例、丙戊酸钠组45例和卡马西平组31例的癫癇患儿及36例未用药物治疗的癫癇患儿进行血钙、磷、碱性磷酸酶和骨密度的测定。结果血钙浓度TPM组和VPA组均较对照组高,CBZ组则较对照组低(P均<0.05);血磷浓度TPM组与CBZ组均较正常对照组低(P<0.05),VPA组与对照组相比差异无统计学意义(P>0.05);血碱性磷酸酶各组间差异无统计学意义(P>0.05)。骨密度测定,发现3个治疗组患儿均有不同程度的骨密度降低(P<0.05),并且和服药时间呈显著负相关。结论新型抗癫癇药如托吡酯亦可导致癫癇患儿骨代谢异常,且骨密度与服药时间呈负相关。     

常用抗癫癎药物对小儿机体诱变作用

目的　通过检测外周血淋巴细胞姊妹染色体交换 (SCE)频率及血清叶酸 (FA)水平 ,研究抗癫药物 (AEDs)对机体的诱变作用及其对FA代谢的影响 ,寻求抗诱变作用的途径。方法　选择癫患儿 90例 ,依据应用AEDs不同分组 ,检测各组用药前后SCE频率及FA水平 ,以及补充FA后两指标变化。结果　服用卡马西平 (CBZ)和丙戊酸钠 (VPA)的癫患儿 ,服药后较服药前血清FA明显降低 ,SCE频率显著升高 ,而补充服用FA后两指标有明显改善。结论　CBZ、VPA对小儿机体具有诱变作用 ,但硝基安定无明显诱变作用。FA能够减轻AEDs对机体的诱变作用。     

One vs. two years of anti-epileptic therapy in children with single small enhancing CT lesions

The duration of anti-epileptic drug (AED) therapy in children with seizures due to single small enhancing CT lesions (SSECTL) is controversial. We sought to determine whether there is any difference in the rate of seizure recurrence after 1 vs. 2 years of AED therapy and to identify the factors predictive of seizure recurrence. A total of 115 consecutive children with seizures and SSECTL were randomly assigned to two groups. Group A received AED(s) for 1 year and Group B for 2 years seizure-free interval. CT scan and EEG were done prior to AED withdrawal and children were followed-up for seizure recurrence for at least 1 year. Association between seizure recurrence and clinical and CT characteristics was analysed. Groups A and B consisted of 55 and 51 children, respectively (nine were lost to follow-up). There were 61 boys and 45 girls; mean age 9.33 years. Most (93 per cent) had focal seizures: 36 per cent complex partial, 22 per cent simple partial, 35 per cent partial with secondary generalization; 21 per cent had status epilepticus. The two groups were comparable in clinical, EEG and CT characteristics. CT scan and EEG prior to AED withdrawal were abnormal in 44 per cent and 33 per cent respectively. Six children, three from each group had seizure recurrence. Significant association was found between seizure recurrence and abnormal CT (persistence/calcification of lesion) and abnormal EEG prior to AED withdrawal (p < 0.01). The relative risk of seizure recurrence in a child with abnormal CT and EEG prior to AED withdrawal was 26.2 (95 per cent confidence interval 3.3-210.2, p = 0.0003). No association was found between seizure recurrence and any of the other variables. There was no difference in seizure recurrence after 1 vs. 2 years of AED therapy. Combination of persistent/calcified CT lesion and abnormal EEG prior to AED withdrawal was the best predictor of seizure recurrence.     

Antiepileptic drug withdrawal in childhood epilepsy: What are the risk factors associated with seizure relapse?

BackgroundIn recent years, several studies have been conducted to determine the risk of relapse after antiepileptic drug (AED) withdrawal: there is no general agreement on criteria that can predict safe discontinuation or seizure recurrence.AimsTo evaluate prospectively the relapse rate of epilepsy associated to AED withdrawal in epileptic children and to determine the risk factors of seizure recurrence.MethodsOne hundred-sixty-eight children with epilepsy who were seizure-free for at least 2 years were enrolled and all children were proposed to stop AED treatment and were followed. In all children electroencephalograms (EEGs) were performed before the withdrawal of AEDs and after discontinuation of the treatment.ResultsA total of 48 (28.6%) children relapsed; half of these patients relapsed while reducing the AED dose and the other half after the AED was withdrawn; after 2 years without AEDs, the risk of relapse was very low. Data evaluated by multivariable analysis showed that the children receiving polytherapy before AED withdrawal, having a history of febrile seizures and suffering from multiple seizure types relapsed more frequently. The presence of abnormal post-withdrawal EEG recordings was associated with a higher risk of seizure recurrence.ConclusionsEpileptic children, after a seizure-free period of 2 years, have a low risk of seizure recurrence. The potential risk factors of relapse, are multiple seizure types previous polytherapy, history of febrile seizures and abnormalities in post-withdrawal EEG.     

Thyroid dysfunction associated with increased low-density lipoprotein cholesterol in epileptic children treated with carbamazepine monotherapy: A causal relationship?

OBJECTIVE: Lipid abnormalities and thyroid dysfunction have been reported in patients treated with antiepileptic drugs. The aim of this study was to evaluate prospectively the association between thyroid and lipid profile in children treated with carbamazepine (CBZ) monotherapy. MATERIALS AND METHODS: Thyroid function was evaluated in 18 epileptic children, previously reported with CBZ-induced changes in serum lipid profile, before and at 6, 12 and 24 months of CBZ monotherapy. RESULTS: All children had normal thyroid function before the initiation of CBZ treatment. During CBZ therapy thyroid dysfunction, with increased thyrotropin (TSH) and decreased thyroxine (T4), free thyroxine (FT4) and triiodothyronine (T3) was found, while, significant association was revealed between serum low-density lipoprotein cholesterol (LDL-C) and TSH levels at 6 (r=0.469; p=0.043) and 12 (r=0.730; p=0.001) months of treatment. CONCLUSION: Lipid abnormalities may be associated with thyroid hormone disturbance in children treated with CBZ monotherapy. Since thyroid dysfunction and hypercholesterolemia are both associated with a higher atherosclerotic risk special attention and further studies are needed in epileptic patients treated with CBZ monotherapy.     

托吡酯和卡马西平对癫癎患儿骨代谢的影响

目的：探讨抗癫癎药托吡酯(topiramate,TPM)和卡马西平(carbamazepine,CBZ)对癫癎患儿骨代谢的影响。方法：对63例单独服用TPM和CBZ的癫癎患儿及36例未用药物治疗的癫癎患儿（对照组）进行血钙、磷、碱性磷酸酶和骨密度的测定。结果：TPM组血钙浓度2.41±0.17 mmol/L,较对照组的2.26±0.11 mmol/L高,CBZ组2.15±0.26 mmol/L,较对照组低（均P0.05）。与对照组比较,TPM和CBZ组患儿均有不同程度的骨密度降低(P<0.05)。结论：托吡酯和卡马西平均可引起血钙、磷的异常变化和骨密度的降低。［中国当代儿科杂志,2010,12（2）：96-98］     

Serum lipids in epileptic children treated with carbamazepine and valproate

Serum total cholesterol (TC), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C) and very low-density lipoprotein cholesterol, triglyceride, apolipoproteins A1 and B levels were studied in 57 healthy children and in 39 children with epilepsy who had been receiving carbamazepine (CBZ) (23 children) for 1.58 ± 1.10 years or valproic acid (VPA) (16 children) for 1.34 ± 1.11 years. In patients receiving CBZ, mean TC level, mean LDL-C level, mean TC/HDL-C ratio and mean LDL-C/HDL-C ratio were significantly higher than controls. None of the mean levels of serum lipids evaluated in patients receiving VPA was significantly different from the corresponding control group mean. Changes in serum lipids correlated with neither duration of therapy or plasma antiepileptic levels nor age or gender. Conclusion Our results suggested that CBZ, a hepatic-enzyme-inducing drug, affects serum lipid status. Long-term prospective studies are necessary to determine whether chronic CBZ therapy is a risk factor for atherosclerotic disorders. Received: 15 October 1996 / Accepted: 5 February 1997     

不典型儿童良性部分性癫(癎)患儿癫(癎)性负性肌阵挛的临床和神经电生理研究

目的 探讨不典型儿童良性部分性癫(癎)(ABPE)患儿癫(癎)性负性肌阵挛(ENM)的临床和神经电生理特点及对治疗的反应.方法 对1998年1月至2007年9月在北京大学第一医院儿科就诊的17例伴ENM的ABPE患儿在视频脑电图(VEEC)监测下行直立伸臂试验,9例同时监测双侧三角肌表面肌电图(EMG).对ENM的临床、神经电生理特征及对抗癫(癎)药物(AED)的治疗反应进行分析.结果 本组起病早期均符合儿童良性癫(癎)伴中央颞区棘波(BECT)的诊断标准,并已接受AED治疗.病程中出现手抖、掉物、点头、站立不稳等症状提示可能存在ENM.所有患儿均在VEEG监测时行直立伸臂试验并观察到ENM发作,与EEG对侧Rolandic区高波幅棘慢波发放同步出现.9例同时进行EMG记录,证实EEG的棘波与EMG的短暂肌电静息具有锁时关系.在出现ENM期间,原有的部分运动性发作频率及发作间期EEG放电明显增多,6例亦有不典型失神发作.部分患儿ENM的出现可能与加用卡马西平、奥卡西平、苯巴比妥等药物或突然减停丙戊酸有关.丙戊酸、苯二氮革类药物及肾上腺皮质激素以不同方式联合治疗可消除多数患儿的ENM发作.结论 ABPE病程中可出现ENM.VEEG监测时行直立伸臂试验及同步EMG记录有助于确诊ENM.ENM的出现常伴有原有惊厥发作频率的增多及发作间期EEG的恶化.卡马西平等AED可能诱发ENM.丙戊酸、苯二氮革类药物及肾上腺皮质激素对消除ENM发作有效. NM期间,原有的部分运动性发作频率及发作间期EEG放电明显增多,6例亦有不典型失神发作.部分患儿ENM的出现可能与加用卡马西平、奥卡西平、苯巴比妥等药物或突然减停丙戊酸有关.丙戊酸、苯二氮革类药物及肾上腺皮质激素以不同方式联合治疗可消除多数患儿的ENM发作.结论 ABPE病程中可 现ENM.VEEG监测时行直立伸臂试验及同步EMG记录有助于确诊ENM.ENM的出现常伴有原有惊厥发作频率的增多及发作间期EEG的恶化.卡马西平等AED可能诱发ENM.丙戊酸、苯二氮革类药物及肾上腺皮质激素对消除ENM发作有效. NM期间,原有的部分运动性发作频率及发作间期EEG放电明显增多,6例亦有不典型失神发作.部分患儿ENM的出现可能与加用卡马西平、奥卡西平、苯巴比妥等药物或突然减停丙戊酸有关.丙戊酸、苯二氮革类药物及肾上腺皮质激素以不同方式联合治疗可消除多数患儿的ENM发作.结论 ABPE病程中可 现ENM.VEEG监测时行直立伸臂试验及同步EMG记录有助于确诊ENM.ENM的出现常伴有原有惊厥发作频率的增多及发作间期     

Topiramate as a new antiepileptic drug in epileptic children in Iran

Objective It is known that current antiepileptic drugs cannot control seizures in 20–30% of patients. The aim of this study was to evaluate the efficacy and safety of topiramate (TPM) as add-on therapy in intractable epileptic children in Iran. Methods As a quasi- experimental (before and after) study, 42 iranian children aged 1–15 years, 28 boys and 14 girls with refractory seizures seeking treatment were recruited to be subjects of this study. Results Type of seizures of those 42 epileptic children were as follows: L.G.S. (n=14), idiopathic epilepsy (n=8), symptomatic epilepsy (n=16) and progressive myoclonic epilepsy (n=4). At the end of three months of treatment in which topiramate was used concomitantly with previous AED, 17% became seizure free, 26% had more than 50% reduction of seizure frequency and 5% of them had increasing seizures. Therefore, the drug is statistically significant in seizures reduction. The efficacy of the drug was statistically significant in idiopathic and symptomatic epilepsy. The author’s did not notice any serious side effects such as: hematologic abnormality, hepatotoxicity and nephrotoxicity. Conclusion This study supports efficacy and safety of TPM in controlling of intractable epilepsy in children and indicates the drug should be considered as an add-on therapy in the management of refractory epileptic syndromes.     

The effects of long-term anticonvulsive treatment on serum lipid profile

Serum lipids were determined in 10 untreated patients with recently diagnosed epilepsy, 21 patients treated with carbamazepine (CBZ), 10 patients treated with valproate (VPA) and in 15 healthy children. In relation to the controls, patients receiving CBZ showed increased serum high-density lipoprotein cholesterol (HDLc), apolipoprotein A (Apo-A) and apolipoprotein B (Apo-B). Patients receiving VPA showed increased Apo-B levels. There were no significant differences in total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDLc) or very low-density lipoprotein cholesterol (VLDLc) between all groups. The changes in lipid metabolism may be associated with the induction of liver enzymes during anti-epileptic drug metabolism. The CBZ-induced change in serum lipid levels was considered to be a possible factor against atherosclerosis and coronary heart disease in epileptic patients.     

Increased chromosomal breakage in epileptic children after long-term treatment

To investigate the mutagenic effects of antiepileptic drugs (AED), 39 epileptic children treated by long-term monotherapy (10 cases with Pb, 11 with Cbz, 9 with Vpa, 8 with Pht) have been studied.The long-term administration was monitored by measurement of AED serum concentrations by gaschromatography. Metaphase chromosome observations were performed using short time culture of peripheral blood lymphocytes and 100 mitoses from each proband were analyzed. A significant increase of CA in the group of patients with Pb (0.23), Cbz (0.19), Vpa (0.25), Pht (0.18) as compared with those of nine epileptic children without treatment (0.08) has been found. Because unrepaired damage of DNA may act as a possible carcinogenic potential, the shortest possible duration of AED treatment is recommended.Abbreviations AED antiepileptic drugs - Pb phenobarbital - Cbz carbamazepine - Vpa valproic acid - Pht phenitoine - CA chromosomal aberrations - SCE sister chromatid exchange     

卡马西平、丙戊酸钠、托吡酯对3～12岁癫癎儿童骨代谢的影响

目的探讨抗癫癎(EP)药物(AEDs)卡马西平(CBZ)、丙戊酸钠(VPA)、托吡酯(TPM)对EP患儿骨代谢影响。方法实验组为90例3～12岁原发性EP患儿,根据治疗药物不同随机分为CBZ、VPA、TPM组各30例。除口服上述药物外未予其他任何药物治疗,疗程6～12个月。于治疗前和治疗后3、6个月分别测定骨密度(BMD)、骨碱性磷酸酶(BAP)、血钙、磷、碱性磷酸酶(ALP)。对照组为30例未治疗原发性EP患儿,同期检测上述指标。对上述骨代谢指标进行评价。结果实验组治疗前后BMD、BAP、钙、磷、ALP与对照组比较无显著性差异(Pa>0.05)。实验组CBZ、VPA、TPM治疗前后5种骨代谢指标比较亦无显著性差异(Pa>0.05)。结论短期服用CBZ、VPA、TPM对3～12岁EP患儿骨代谢无影响。     

Comparison of steady-state pharmacokinetics of valproic acid in children between monotherapy and multiple antiepileptic drug treatment

Steady-state pharmacokinetics of valproic acid (VPA) with or without other antiepileptic drug (AED) treatment were studied in 37 children. Children (N = 16) receiving multiple AED therapy had a higher clearance (23.5 vs 13.0 ml/hr/kg, P less than 0.001), larger volume of distribution (0.30 vs 0.22 L/kg, P less than 0.01), and shorter half-life (9.4 vs 12.3 hours, P less than 0.01) than did those (n = 21) receiving VPA only. Inverse correlations of age with clearance (R = -0.559, P less than 0.01) and apparent volume of distribution of VPA (r = -0.490, P less than 0.05) were observed in children receiving monotherapy. In determining the dose and dosing interval of VPA, consider a possible alteration in the pharmacokinetics relating to age and other concurrent AED therapy.     

Influence of long-term carbamazepine treatment on thyroid function

We have studied the effects of carbamazepine on thyroid function in sixteen recently diagnosed epileptic children and thirteen epileptic children receiving long-term carbamazepine therapy and compared these findings with the thyroid function of thirteen healthy control subjects. Thyrotropin (TSH), tri-iodothyronine (T₃), thyroxine (T₄), free tri-iodothyorinine (FT₃) and free thyroxine (FT₄) serum levels were determined in both recently diagnosed but as yet untreated epileptic children and normal controls. These hormone levels were determined again after 2 months of treatment and 12 months of treatment in epileptic children. No statistically significant difference was found in the endocrine parameters of untreated epileptic children and the normal control group. After both 2 months and 12 months of carbamazepine therapy, serum levels of T₄, FT₄ and FT₃ were found to be low, but the serum T₃ concentration was unaffected. Baseline TSH levels were not changed during carbamazepine therapy either. Serum TSH levels increased rapidly after thyrotropin-releasing hormone stimulation in both the before and 12 months after carbamazepine treatment groups, but the response was higher in the 12 months treatment group. The findings of the present study suggest that accelerated hormone metabolism is responsible for hormonal changes found in patients treated with carbamazepine. Carbamazepine also had effects on the function of the hypothalamo-pituitary axis.     

Factors predicting the risk of relapse after antiepileptic drug discontinuation in children with partial seizures

The purpose of this study is to identify possible factors which could influence the seizure recurrence after anti-epileptic drug (AED) withdrawal in children with partial epilepsy. AED was discontinued in 82 children who had been free of partial epileptic seizures for 2.0–11.0 years (mean 4.7 years). Twenty-four patients (29.3%) had a relapse from a few days to 6.1 years (mean 1.2 years) after AED discontinuation. Significantly more common in children who relapsed were: younger age at beginning of AED withdrawal, occurrence of complicated febrile convulsions (5/24 vs 1/58,P<0.01), abnormal neurological examination (8/24 vs 8/58,P<0.05), delayed psychomotor development (7/24 vs 7/58,P<0.05), focal slowing (6/24 vs 3/58,P<0.01) and focal epileptiform discharges (7/24 vs 6/58,P<0.05) in the last EEG before AED discontinuation. Between the two groups no statistical significant differences no statistical significant differences concerning the age at onset of seizures, the duration at AED therapy after the last seizure, the familial occurrence of epilepsy and background EEG abnormalities in the last EEG before AED discontinuation were found. On the basis of EEG, occurrence of febrile convulsions, and neurological and developmental examination it may be possible to predict which children have the best chance to remain free of recurrence after AED discontinuation.Presented in part at the European Congress of Epileptology, Oporto, Portugal, September 6–10, 1994