AED discontinuation may not be dangerous in seizure-free patients

The decision to continue or to stop anticonvulsant treatment in patients with prolonged seizure remission is still a matter of debate. There is no evidence that continued treatment guarantees permanent seizure freedom. Up to 50% of patients achieve terminal remission (i.e., off drugs). Almost one-half of patients with untreated epilepsy are seizure-free for more than 5 years and the number of those with continuing seizures tends to decrease over time. In contrast, a substantial fraction of patients on chronic treatment with antiepileptic drugs (AEDs) may be exposed to clinically relevant adverse effects. Other disadvantages of continuing treatment indefinitely include the teratogenic risk, drug interactions, and the concern that AEDs may be unnecessary. The probability of remaining seizure-free after treatment discontinuation is about 70% at 2 years. Although different combinations of factors are thought to affect the risk of relapse, the prediction of individual outcome before withdrawal remains uncertain. As a consequence, the decision to withdraw or withhold treatment must be still individualized. In any patient, the decision to discontinue treatment should also take into account social aspects like driving license, job and leisure activities as well as emotional and personal factors and adverse effects or drug interactions. Patients will ultimately have to decide themselves whether they wish to discontinue drug treatment.