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. [1]

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.