When is it safe to discontinue AED treatment?

When people with epilepsy become seizure-free with daily antiepileptic drug (AED) management, there is a very individual decision to be made about discontinuing this treatment. After 1-6 years of seizure-freedom, it is estimated that 69% of children and 61% of adults remain seizure-free when AEDs are tapered and stopped. The length of time that a patient is seizure-free does not influence the success rate in children but may in adults. The epilepsy syndrome does not seem to influence the chance of success in 75% of children; however, several prediction schemes based on risk factors for recurrence may be useful. There are two major risks in discontinuing treatment--a tiny risk that the epilepsy will not be controlled again and a tiny risk of death during a recurrence. Children who have had 1-2 years seizure-free deserve a chance to discontinue their AED treatment, whereas in adults this decision probably should wait until there have been at least 4 years of seizure-freedom.