Seizure Recurrence After Withdrawal in Children With Epilepsy

What was studied

Researchers combined results from 19 studies involving 3,226 children with epilepsy. They examined how often seizures recurred after antiseizure medications were withdrawn and which factors were associated with recurrence.

The literature search included studies available through May 8, 2025. Two reviewers independently selected studies, extracted data, and assessed study quality.

What they found

The pooled seizure recurrence rate was 28%, with a 95% confidence interval of 23% to 33%.

Factors associated with recurrence included female gender, focal seizures, a history of febrile seizures, developmental delay or intellectual disability, symptomatic etiology, and an abnormal EEG after medication withdrawal.

Limits of the evidence

This meta-analysis identifies associations but does not establish that the listed factors cause seizures to recur. The abstract does not report follow-up duration, withdrawal methods, how long children had been seizure-free, or differences among the included studies. The pooled 28% rate is an overall estimate and may not predict an individual child's risk.

For families and caregivers

The findings support individualized decisions about withdrawing antiseizure medication. A clinician may consider a child's seizure type, developmental history, epilepsy cause, history of febrile seizures, and other clinical information. An abnormal EEG after withdrawal was also associated with recurrence. Having a listed risk factor does not mean recurrence is certain, and lacking these factors does not guarantee that a child will remain seizure-free.

What to watch next

Further research could clarify how recurrence estimates vary with follow-up duration, medication-withdrawal methods, seizure-free duration, and combinations of risk factors. Families can discuss how the study's findings relate to their child's individual circumstances with a clinician.

Terms in this summary

Antiseizure medication withdrawal

Stopping medicine used to prevent seizures, typically under clinical supervision.

Meta-analysis

A study that combines results from multiple studies to estimate an overall result.

Pooled recurrence rate

The combined percentage of children across the included studies whose seizures returned.

95% confidence interval

A range expressing uncertainty around an estimate; here, it was 23% to 33% around the pooled recurrence rate.

Focal seizure

A seizure that begins in a particular area or network of the brain.

Febrile seizure

A seizure associated with fever, usually in a young child.

Symptomatic etiology

Epilepsy attributed to an underlying condition or injury.

EEG

Electroencephalogram, a test that records the brain's electrical activity.