Clinical factors associated with successful antiseizure medication withdrawal

Favorable factors	Unfavorable factors
>2 years of seizure freedom	≤2 years of seizure freedom
Epilepsy onset from 2 to 10 years of age	Epilepsy onset during the neonatal period or after 25 years of age Longer duration of epilepsy prior to remission
Specific epilepsy syndromes: Self-limited epilepsy with centrotemporal spikes Self-limited epilepsy with autonomic seizures Childhood absence epilepsy Childhood occipital visual epilepsy	Specific epilepsy syndromes: Juvenile myoclonic epilepsy Lennox-Gastaut syndrome Lesional epilepsy Focal epilepsies
<10 total seizures prior to ASM withdrawal	≥10 total seizures prior to ASM withdrawal
ASM monotherapy to achieve seizure freedom prior to withdrawal Successful epilepsy surgery with at least one year of seizure freedom	More than one ASM used to achieve seizure freedom EEG with epileptiform discharges prior to ASM withdrawal (especially in children) Developmental delay (ie, IQ <70 or by clinical judgment) History of febrile seizures Family history of epilepsy Faster (≤6 weeks) ASM taper

ASM: antiseizure medication; EEG: electroencephalography; IQ: intelligence quotient.

Courtesy of Joseph I Sirven, MD.

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