[Discontinuation of anti-epileptic drugs]

It is well known that in the long term most patients achieve/gain control over their epileptic crises and the morbidity associated with chronic anti-epileptic drug treatment. We have tried to review the criteria for discontinuation of such treatment and evaluate drug toxicity and the risks of discontinuation.

It is correctly accepted that 70-80% of all epileptic patients experience remission of the disorder, in most cases easily. The greatest risk of recurrence after discontinuation of treatment is during the first year (25-30%). The most important factors to consider with regard to the risk of recurrence are: the age at onset (in nearly all the series studied there was less risk of recurrence when onset occurred before the age of 12, aetiology (greater risk in symptomatic than in idiopathic crises) and EEG (there is a greater risk when focal slowing or bilateral paroxystic activity is seen).

The ideal type of patient in whom to discontinue anti-epileptic drugs is a patient who has been free of crises for two years whilst being treated, only one type of crisis present which as always been well controlled, normal neurological examination and IQ, idiopathic epilepsy (except for juvenile myoclonic epilepsy) and with normalization of the EEG whilst on treatment. The decision to discontinue treatment should be made jointly with the patient, especially when adult, regarding fundamental aspects such as driving vehicles and the problem of work and/or loss of a job.