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. 2025 Mar;40(3):200-207.
doi: 10.1177/08830738241292836. Epub 2024 Dec 10.

Assessing the Need for Repeat EEG in Pediatric Patients with Idiopathic Generalized Epilepsy After Anti-Seizure Medication Withdrawal Following Seizure Freedom

Sita Paudel  1 , Madison Heebner  2 , Gayatra Mainali  1 , Jaclyn S Tencer  1 , Rhea Kanwar  2 , Katherine Martel  2 , Ashutosh Kumar  1 , Sunil C Naik  1 , Sandeep Pradhan  2 , Prakash Kandel  2 , Douglas Leslie  3
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Assessing the Need for Repeat EEG in Pediatric Patients with Idiopathic Generalized Epilepsy After Anti-Seizure Medication Withdrawal Following Seizure Freedom

Sita Paudel et al. J Child Neurol. 2025 Mar.

Abstract

BackgroundMost patients with idiopathic generalized epilepsy have good seizure control on antiseizure medications. Although idiopathic generalized epilepsy subtypes such as juvenile absence epilepsy and juvenile myoclonic epilepsy have a high risk of relapse, childhood absence epilepsy may have seizure remission. After 2 years of seizure freedom in childhood absence epilepsy, typically antiseizure medications are discontinued, but follow-up protocols are unclear. This study aims to evaluate how often patients with idiopathic generalized epilepsy undergo electroencephalography (EEG) after antiseizure medication withdrawal, how often antiseizure medications are restarted based on EEG findings, and if this varies between physicians and advanced practice providers at our institution.MethodsThis was a retrospective chart review. Data were collected using electronic medical records of pediatric patients (<18 years) with idiopathic generalized epilepsy who were successfully weaned off antiseizure medications at Penn State Children's Hospital from 2010 to 2020.ResultsWe reviewed 1409 charts and found 52 patients meeting criteria. Seventeen of 52 patients (32%) had a repeat EEG within 6 months of antiseizure medication withdrawal following seizure freedom. Of those 17 patients, 3 (17.6%) had generalized epileptiform discharges on EEG. Of these 3 patients, 2 (66%) were restarted on antiseizure medications based on the abnormal EEG. None had seizure relapse.ConclusionObtaining a repeat EEG in patients after antiseizure medication withdrawal following seizure freedom is common. Patients with an abnormal EEG are often restarted on antiseizure medications, irrespective of clinical seizure relapse. Considering the high health care costs of EEGs and antiseizure medication side effects, we propose that if patients with idiopathic generalized epilepsy do well clinically following antiseizure medication withdrawal, EEGs may not be necessary.

Keywords: EEG; antiepileptic drugs; antiseizure drugs; electroencephalography; epilepsy.

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Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Patient demographics flowchart. ASM, antiseizure medication; EEG, electroencephalography.
Figure 2.
Figure 2.
Histograms for rate of repeat electroencephalogram (EEG) by idiopathic generalized epilepsy syndrome. CAE, childhood absence epilepsy; IGE, idiopathic generalized epilepsy.
Figure 3.
Figure 3.
Rate of repeat electroencephalogram (EEG) by patients restarted on antiseizure medication.
Figure 4.
Figure 4.
Frequency of antiseizure medications started by physician (MD/DO) vs advanced practice provider (APP) prior to Withdrawal.
See this image and copyright information in PMC

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