Towards a comprehensive approach in the management of epilepsy

There is a lack of data concerning risks associated with discontinuation of anticonvulsant medication in epileptics. Lately, there have been a number of studies addressing this problem. Some have shown that significant proportions of patients remain free from seizures after drug withdrawal. There has been some confusion as to which factors are predictive of a good or bad outcome. A recent study has added useful information in this area [see Therapy Section, this issue, p8J. Specifically, Callaghan et al. found that monotherapy could be discontinued in selected adults just as safely as in children, with similar relapse rates. Several variables were found to be strongly predictive of outcome, namely, the seizure type, EEG findings, the response to drug therapy and the particular drug withdrawn.

This study is important because there is growing evidence that long term anticonvulsant therapy affects cognitive and behavioural neurological function, aside from well known effects on other systems.

However, it is unreasonable to advocate drug withdrawal in all cases of epilepsy, particularly as some patients are bound to fare badly. Each patient needs to be comprehensively evaluated, according not only to known risk factors but also to psychosocial variables. Pedley TA. New England Journal of Medicine 318: 982·984, 14 Apr 1988

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