After a period of at least 2-3 years free from seizures, withdrawal of antiepilepsy drug therapy can be considered. The prognosis of a seizure disorder is determined by a number of factors. Some are known to remit spontaneously e.g. benign rolandic epilepsy and petit mal, whereas others never remit e.g. juvenile myoclonic epilepsy. In many types of epilepsy the outlook is less certain and only general indicators are available. The following factors can be important:
• The type of seizure disorder — major seizures are more easily controlled.
• The time to remission — early remission carries a better outlook.
• The number of drugs required to induce remission — rapid remission on a single drug is a favourable indicator for successful withdrawal.
• The presence of an underlying lesion — control is often difficult.
• The presence of an associated neurological deficit or learning difficulty — control is often difficult.
In general, if a patient with a major epilepsy has no neurological deficit or structural lesion and is of normal intelligence, there is a reasonable chance of continued remission, particularly if this is rapidly achieved with a single drug. In general, in adult epilepsy, discontinuing the antiepilepsy drug is associated with about 20% relapse during withdrawal and a further 20% relapse over the following 5 years; after this period relapse is unusual. It is generally recommended that the antiepilepsy drug be withdrawn over a period of 6 months. If a fit occurs during this time, full therapy must be resumed again until the patient has been free from seizures for a further 2-3 years.
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