Cessation of epilepsy therapy in children

In epileptic children experiencing a seizure-free period, the target is to attempt antiepileptic drugs (AEDs) withdrawal. When clinicians have to decide whether to discontinue antiepileptic therapy or not, they should consider the risk of seizure relapse. Several studies have tried to identify the main factors associated with seizure recurrence after AEDs withdrawal. Analysing these data, it is possible to identify patients with a different risk and, consequently, to decide whether or not to begin therapy withdrawal. In this review, data from literature have been examined to delineate a therapeutic approach in children. Factors at risk of relapse are abnormal EEG, age at onset before 2 years or after 10 years, defined aetiology, mental retardation and seizure free period. Although larger prospective studies are needed, a seizure free period of at least 2 years before withdrawal and a slow tapering of AEDs are recommended.