A practical guide to when (and how) to withdraw antiepileptic drugs in seizure-free patients.

Most patients with epilepsy will become seizure-free on antiepileptic drugs (AEDs) within a few years of diagnosis. More than 60% will remain so when the medication is withdrawn. After assessing the risks and benefits for the individual patient, withdrawal may be considered by the physician and informed patient or parent if the patient meets the following profile: normal neurological examination, normal IQ, normal electroencephalogram (EEG) prior to withdrawal, seizure-free for 2 to 5 years or longer, and no juvenile myoclonic epilepsy. AEDs can be safely withdrawn in the seizure-free patients over the course of 6 months, possibly even faster, especially in children.