The results of antiepileptic drug discontinuation in epileptic children who were seizure free for at least 2 years are reported from the Services of Child Neurology and Psychology, Department of Neurology, Clinics Hospital University of Sao Paulo Medical School, Sao Paulo, Brazil. Twenty children (28%) had a recurrence, 75% during discontinuation or less than 6 months after discontinuation of AED. The risk factors related to seizure recurrence were 1) more than 10 seizures before seizure control, 2) abnormal EEG in the year before discontinuation, 3) focal neurologic signs and/or mental retardation, and 4) a mixed seizure pattern. Two or more risk factors were associated with recurrence of seizures in 14 children (70%), whereas patients with none or only 1 risk factor had no recurrence (72%). [1]

COMMENT. Risk factors may be of help in determining the safety of discontinuing antiepileptic medications in children who are seizure free for a period of at least 2 years. There was no correlation between age at seizure onset and recurrence in this study, which is at variance with some other reports.

A finding of a higher sleep tendency in children with epilepsy than in controls, even 4-5 months after drug discontinuation, was unexpected in a study from the University of Lund, Sweden [2]. A long time had passed since the last reported seizure and the EEG was free of epilepti-form activity in most cases, so that the sleepiness could not be a direct effect of epileptic seizures.