The recurrence risks and predictive factors of relapse after antiepileptic drug (AED) discontinuation in a prospective analysis of 425 children with epilepsy are reported from the Instituto di Neuropsichiatria Infantile, Universita La Sapienza, Via dei Sabelli, Rome, Italy. AEDs were discontinued in children who had not had seizures for at least two years and the follow-up after withdrawal was 1.6 to 12 years, mean 8 years. The relapse rate after drug withdrawal was 12% and the risk was greatest in the first year. Factors related by multivariate analysis to relapse were neurologic abnormalities and organic etiology, mental retardation, seizure type (infantile spasms, absence seizures), and appearance or persistence of EEG abnormalities during the course of the illness and before discontinuation of the drugs. [1]

COMMENT. The authors believe that drug withdrawal can be attempted in patients with well controlled idiopathic epilepsy, without signs of brain damage and without persistent EEG abnormalities. They stress that predictive factors must be considered to individualize the risk of relapse for each patient.