title: Stopping epilepsy treatment in seizure remission: Good or bad or both?
abstract: OBJECTIVE
  To review the outcome of epilepsy after stopping antiepileptic drugs in remission.
  
  
  RESULTS
  Stopping antiepileptic drugs (AEDs) in remission is routinely done in many patients. Although the consequences of an unexpected relapse seizure in the 2 years after stopping AEDs may cause anguish and social issues, the impact on the long term seizure outlook of the epilepsy is minimal, if any. Discontinuation of drug treatment does not seem to affect the long-term prognosis but exposes patients who were seizure-free for years to a transient two-fold risk of seizures for the first 2 years after stopping AEDs. In addition, 20% of patients who were seizure-free for years, do not become seizure-free immediately after restarting AED treatment after relapse. The list of potential pitfalls is long. Patients with juvenile myoclonic epilepsy, those with prior withdrawal attempts and late remission have a higher risk of relapse.
  
  
  CONCLUSIONS
  Stopping AEDs in remission does not affect the long-term patterns of epilepsy and some patients report a better general health in a life without AEDs. High-risk patients should not be generally encouraged to stop their AEDs in remission. We need new drugs that combine anti-seizure and antiepileptogenic effects to prevent seizure relapse and flare up of epilepsy after stopping AEDs in remission.
authors.affiliation: Epilepsy Research Group, Berlin, Germany. Electronic address: dbschmidt@t-online.de.
authors.forename: Dieter
authors.initials: D
authors.lastname: Schmidt
authors.affiliation: Departments of Public Health and Child Neurology, University of Turku, and Department of Child Neurology, Turku University Hospital, Turku, Finland; Department of Public Health, University of Turku, Turku, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Sillanpää
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects*; D004827:Epilepsy / Q000628:therapy*; D006801:Humans; D012008:Recurrence; D012640:Seizures / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D000927:Anticonvulsants
keywords: AED withdrawal: long-term seizure prognosis; Drug-treated epilepsy; Natural course; Pitfalls in stopping AEDs; Relapse seizures; Stopping AEDs