Antiepileptic drug withdrawal--a good idea?

Patients who are seizure free for 2 years or more are candidates for antiepileptic drug (AED) withdrawal. A MEDLINE search of the English language literature from 1980-1996 was performed to identify articles dealing with AED withdrawal in both adults and children. Factors examined included advantages and disadvantages of withdrawal, risks of relapse, prognostic factors of outcome, and methods of withdrawal. Advantages include psychosocial benefits, cost savings (direct drug costs, indirect monitoring costs), and avoidance of adverse effects and toxicity. The benefits must be balanced against the risks and impact of seizure relapse, which are different for each individual patient. A review of the prognostic factors that influence the risk of relapse will aid clinicians in determining appropriate candidates for AED withdrawal.