Abstract
The Königsteiner Arbeitskreis (KA) discussed the optimal timing of discontinuation of antiepileptic drugs (AE) in children. Because the controlled trials are rare and inconsistent it was decided to publish the results of the discussion and the approach of the KA members. In neonates AE are usually withdrawn within 2-12 weeks after the last seizure. In infantile spasms, vigabatrin is discontinued 6-12 and sulthiam 6-36 months after the cessation of spasms. After steroids the majority of the KA members continue AE for 2 years. For Rolandic epilepsy 1-3 seizurefree years seem to be sufficient to stop AE, even when focal spike waves persist. In symptomatic focal epilepsy the decision of discontinuation is influenced by the underlying disease. In absence epilepsy AE are discontinued after 2 years; whereas in myoclonic astatic epilepsy most members prefer 2-5 seizure-free years before AE are tapered. Agreement exists about the high risk of relapse after withdrawal of AE in juvenile myoclonic epilepsy and the majority of the members never stop AE in patients with this syndrome. Some KA members however, consider discontinuation after 2-3 seizure-free years. With respect to the rate of withdrawal, most members prefer a slow (3-12 months) tapering. Rapid (< 3 months) tapering is practised only by 2 KA members. The role of EEG for the decision of AE discontinuation is limited to some epileptic syndromes (i.e. absence epilepsy). The paper reflects the opinion of the KA and is not feasible as a guideline. The decision to discontinue AE is always an individual decision based on the underlying disease, the kind of epilepsy and the psychosocial circumstances of the patient
Schmitt, Bernhard