When and how to stop antiepileptic drugs

The informed decision to stop anticonvulsant treatment in patients with prolonged seizure remission requires assessing the risk of seizure relapse and predisposing factors. Although the probability of remaining seizure-free after treatment discontinuation is about 70%, patients at greater risk for relapse include those still presenting abnormal EEG and/or a documented etiology of epilepsy. In addition, seizure outcome depends on the syndromic pattern. Even though these indicators may be strongly influential, 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, emotional and personal factors, and adverse effects or drug interactions. Patients and caregivers should be informed of the benefits and the risks associated with treatment discontinuation and should be actively involved in the decision process.