[Withdrawal of antiepileptic treatment in adults]

The withdrawal of antiepileptic treatment is a major challenge for the epileptologist who has to make a decision involving two risks, namely long term maintenance of drug treatment and recurrence of the seizures.

In our review we wish to systematize the process of decision-making and calculation of the possibilities of recurrence.

First we review the factors to be considered when making a decision. This is complex since epileptics are a very heterogeneous group of patients. We emphasize the respect due to the patient who, in the end, is the one who assumes the risk involved. Then we consider the factors to be taken into account when calculating the individual's possibilities of having a recurrence and describe a theoretical outline of non-recurrence. Finally, we give details of the practical aspects of withdrawal of treatment.

We emphasize that the current challenge in this field is to design a method of measuring risks to permit the prediction of probabilities of recurrence in individual patients. We quote examples of the classification and measurement of risks, and suggest that only by institutional measures--perhaps by organizations such as LECE--can further essential epidemiological studies, of great scientific interest in the long term, be carried out.