Withdrawal of antiepileptic drugs (AEDs) in seizure-free patients, risk factors for relapse with special attention for the EEG

Abstract

When a patient has remained free from seizures for several years while taking antiepileptic drugs (AED) the question arises whether or not the medication can be withdrawn. Therefore it would be desirable to be able to identify reliably those patients who will remain seizure-free without treatment. Numerous variables might be of prognostic importance but our knowledge about the significance of demographic, genetic, aetiological, pathophysiological and treatment-related factors remains extremely poor. Although an abnormal inter-ictal EEG has been repeatedly cited as predictive of relapse during and after AED withdrawal, there is little evidence to support this view. There is a need for more precise individual prediction of risk but as long as patients with forms of epilepsy with widely varying prognosis are grouped together in AED withdrawal trials the outcome of these trials will never reach consensus about the relapse risk and about the possibility of predict relapse in individual patients.