Treatment withdrawal in drug-responsive epilepsy

Antiseizure medication (ASM) therapy effectively controls seizures in the majority of patients with epilepsy. Approximately two-thirds of patients with epilepsy will become seizure free with appropriate pharmacotherapy. The International League Against Epilepsy (ILAE) defines seizure free or medically responsive epilepsy as seizure freedom for ۱۲ months or ۳ times the longest previous interseizure interval, whichever is longer. This definition is handily referred to as “the rule of three.”Several studies in children have reported that an age of onset older than ۱۰ or ۱۲ years was associated with a higher recurrence risk, presumably because this already reflects early adult-onset epilepsy.Epileptic children, after a seizure-free period of ۲ years, have a low risk of seizure recurrence. The potential risk factors of relapse, are multiple seizure types, previous polytherapy, history of febrile seizures and abnormalities in post-withdrawal EEG.Studies of withdrawing ASMs in adult’s report recurrence rates of ۲۸% to ۶۶% which is a much larger range than that reported in pediatric studies (the higher risk of recurrence in adolescent-onset seizures).As a result, Clinically, it is important to identify subgroups with better or less favorable prognoses for maintaining seizure remission off medications. It is essential to quantify the significance of risk factors such as etiology, age of onset, type of seizure, and the EEG; however, different studies give very different results.