[Discontinuing of antiepileptic therapy]

The merits of suspending the treatment of children suffering from epilepsy must be evaluated under a number of different headings. It may be justified in the light of side effects brought about by the drugs administered, or on the basis of a favourable prognosis that often characterises these form of epilepsy. The current tendency is to start reducing the dosage of drugs 2-3 years after the complete remission of the seizures, fully suspending treatment 6-12 months thereafter. Greater prudence is called for in cases where the containment of seizures has proved particularly problematic. Despite these precautions, relapses have been found to occur in 15-30% of patients, during both the reduced dosage period and once treatment has been discontinued (normally within the first year). Subjects with brain injury and those effected by particular forms of epilepsy (myoclonic epilepsy, grand and petit mal status, complex epileptic attacks) are more prone to relapse, particularly when seizures have been very frequent. Adolescence and, according to many Authors, persistent EEG alterations, also represent negative factors. In most cases, seizures can be controlled once treatment is resumed. In all cases, the problems associated with the withdrawal of anti-epileptic treatment must be discussed carefully with the patient and his or her family; an attempt should be made to identify the risks involved and the patient must be followed closely during the delicate discontinuance period.