Reader Response: Uncertainties from a worldwide survey on antiepileptic drug withdrawal after seizure remission

I read with interest the results of the Bartolini et al.¹ worldwide survey on antiepileptic drug (AED) withdrawal after seizure remission. As the authors state, the survey results highlight the pressing need for well-designed studies exploring these issues and the development of standardized guidelines that can guide decision-making when physicians are confronted with the issue of AED withdrawal after seizure remission. In the end, though, every patient is an n of 1 and AED withdrawal decision has to be individualized taking into consideration intrinsic patient factors (type of epilepsy, natural history of that epilepsy/epilepsy syndrome, level of seizure control, seizure type [focal vs generalized], presence vs absence of structural epileptogenic lesion on MRI, presence vs absence of interictal epileptiform discharges on EEG, driving status, socioeconomic status including ability to afford medications) and extrinsic factors (ease of access to health care and experience of treating neurologist/epileptologist). One size does not fit all when considering AED withdrawal after seizure remission.

• © 2018 American Academy of Neurology