Drug Withdrawal and Seizure Relapse

Of the patients on AED treatment, 70-80% will eventually become seizure free.1 Because of the possibility of long-term side effects of drugs, it is good practice to consider drug withdrawal after a substantial remission period. There are risks of relapse, however, in doing so and several studies have addressed this issue.13-17 The probability of relapse has varied between 11 and 41%. Most studies in children have reported figures at the lower end of the spectrum while studies in adults tend towards the higher end. A number of risk factors for seizure recurrence after discontinuation of treatment have been identified.14,15 These include a long history of seizures before remission, the occurrence of more than one seizure type, learning difficulties, a past history of remission and relapse and juvenile myoclonic epilepsy. Whether EEG in adults is helpful in predicting recurrence remains controversial. In children, the presence of background slowing or frankly abnormal discharges in the record indicates and increased risk of recurrence.

The Natural History of Untreated Epilepsy

The natural history of untreated epilepsy is unknown as most patients in the modern era can avail of treatment.1 Even though the treatment gap in developing countries can be large in some instances, for various reasons, it is not easy to describe the natural history of untreated seizure disorders. Outcome studies of epilepsy have almost invariably been of the treated condition. Consequently two important questions remain unanswered: what is the possibility of spontaneous remission and what is the effect of early treatment on outcome. The answers to these questions are important in view of the suggestion that the failure to treat epilepsy in its early stages could lead to later intractability.18,19

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