Skip to main content
April 1, 1994

Relapse following discontinuation of antiepileptic drugs
A meta‐analysis

April 1994 issue
44 (4) 601


The estimates in the literature of the risk of seizure relapse after antiepileptic medications are withdrawn range from less than 10% to nearly 70%. There is also little coherence regarding predictors of successful medication withdrawal. We performed a meta-analysis of the published literature to date to determine the risk of relapse at 1 and 2 years after discontinuation of medications and to examine the strength of association between the risk of relapse and three commonly assessed clinical factors: age of onset of epilepsy, presence of an underlying neurologic condition, and an abnormal EEG. We established criteria for inclusion of a study in the analysis, and 25 studies met these criteria. Overall, the risk of relapse at 1 year was 0.25 (95% CI, 0.21 to 0.30) and at 2 years it was 0.29 (95% CI, 0.24 to 0.34). Relative to epilepsy of childhood onset, epilepsy of adolescent onset was associated with a relative risk of relapse of 1.79 (95% CI, 1.46 to 2.19). Compared with childhood-onset epilepsy, adult-onset epilepsy was associated with a relative risk of 1.34 (95% CI, 1.00 to 1.81). Patients with remote symptomatic seizures were more likely to relapse than patients with idiopathic seizures; the relative risk was 1.55 (95% CI, 1.21 to 1.98). An abnormal EEG was associated with a relative risk of 1.45 (95% CI, 1.18 to 1.79). Although these figures help provide an estimate of an individual's likelihood of relapse, they should not be used as the sole basis on which to make the decision on discontinuation of medications. Such a decision rests heavily upon weighing the risks and benefits of continuing and discontinuing medications and includes consideration of both the risk and the consequences of relapse.

Get full access to this article

View all available purchase options and get full access to this article.

Information & Authors


Published In

Volume 44Number 4April 1994
Pages: 601

Publication History

Published online: April 1, 1994
Published in print: April 1994


Request permissions for this article.


Affiliations & Disclosures

Shlomo Shinnar, MD, PhD
Department of Pediatrics, Yale University School of Medicine, New Haven, CT (Dr. Berg)
Departments of Neurology and Pediatrics and the Montefiore/Einstein Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (Dr. Shinnar).

Metrics & Citations



Download Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.

Cited By
  1. Long-Term Pharmacological and Psychosocial Outcomes of Adolescent-Onset Epilepsy: A Single-Center Experience, Annals of Child Neurology, 31, 2, (113-122), (2023).
  2. Best-worst scaling preferences among patients with well-controlled epilepsy: Pilot results, PLOS ONE, 18, 3, (e0282658), (2023).
  3. Drug-mediated antiepileptogenesis in humans, Neurology, 59, 9_suppl_5, (S34-S35), (2023)./doi/10.1212/WNL.59.9_suppl_5.S34
  4. Discontinuation of antiepileptic drugs after successful epilepsy surgery, Neurology, 54, 2, (346-346), (2023)./doi/10.1212/WNL.54.2.346
  5. Antiseizure Medication Withdrawal Practice Patterns, Neurology Clinical Practice, 13, 1, (2023)./doi/10.1212/CPJ.0000000000200109
  6. EEG correlates of seizure freedom in genetic generalized epilepsies, Neurology Clinical Practice, 7, 1, (35-44), (2023)./doi/10.1212/CPJ.0000000000000323
  7. Neuroimaging in Adults and Children With Epilepsy, CONTINUUM: Lifelong Learning in Neurology, 29, 1, (104-155), (2023).
  8. The frequency of intractable seizures after stopping AEDs in seizure-free children with epilepsy, Neurology, 64, 6, (973-975), (2023)./doi/10.1212/01.WNL.0000154517.82748.A7
  9. Seizure outcome in patients with a solitary cerebral cysticercus granuloma, Neurology, 62, 12, (2236-2240), (2023)./doi/10.1212/01.WNL.0000130471.19171.D8
  10. Meta-analysis of EEG test performance shows wide variation among studies, Neurology, 60, 4, (564-570), (2023)./doi/10.1212/01.WNL.0000044152.79316.27
  11. See more

View Options

Get Access

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login
Purchase Options

Purchase this article to get full access to it.

Purchase Access, $39 for 24hr of access

View options

Full Text

View Full Text







Share article link