Of 122 children with tuberous sclerosis complex (TSC) followed at Texas Scottish Rite Hospital for Children, Dallas, TX, 106 (86.9%) had a history of epilepsy. Fifteen of those with epilepsy whose seizures had remitted were followed for a mean of 5 yrs 7 mos (range, 6 mos to 12 yrs 9 mos) after discontinuing antiepileptic drugs (AED). The AED taper period ranged from abrupt withdrawal to 8 mos (mean, 2.3 mos). A retrospective medical record and neuroimaging analysis of the 15 showed that 5 (33.3%) had a relapse of seizures, and AED treatment was restarted. AEDs were subsequently tapered in one of the 5 without a second relapse. The total sustained remission rate was 73.3% (11 of 15), and the absolute relapse rate was 26.7% (4 of 15). Those with sustained remission had mild neurologic findings, a greater likelihood of normal intelligence, normal EEG at time of AED withdrawal, and few cortical and subcortical tubers on neuroimaging. The patients whose seizures relapsed showed a 4:1 girl-boy ratio, and a higher incidence of retardation. The relapse rate was comparable to that of general pediatric epilepsy cases (25% to 31%). The authors conclude that it is reasonable to consider discontinuing AEDs in carefully selected children with TSC and seizure remission of sufficient duration. 
COMMENT. Seizures in tuberous sclerosis patients are often refractory to treatment, and discontinuation of AED treatment is usually considered inadvisable. The above study suggests that in carefully selected patients, a successful withdrawal of medication may be possible. The remission rate may have been greater if AEDs had been tapered more slowly.