[Withdrawal of antiepileptic treatment]

A review is presented of factors influencing the prognosis for remaining free of seizures after withdrawal of anti-epileptic drugs. Adverse factors are found to be: a) being 16 years or older; b) having had many seizures after starting anti-epileptic drug treatment; c) a history of myoclonic seizures; d) a history of generalised tonic-clonic seizures; e) polytherapy; and f) spike and wave paroxysms in the EEG. An EEG before withdrawal of antiepileptic drugs is only required in patients with primary generalised epilepsy. The social situation and individual wishes of the patient and relatives should be considered when withdrawal of anti-epileptic drugs is being planned. Continued treatment until the patient has remained seizure-free for five years will decrease the risk of relapse. In children, anti-epileptic drugs may be withdrawn after three years of treatment, if no adverse factors are present. Nothing definite is known concerning the withdrawal procedure. A stepwise, slow withdrawal with a duration of six months or more is recommended, as this reduces the risk of relapse.