- Design
- Systematic review and meta-analysis
- Population
- 22 studies, 3,933 people with epilepsy who stopped antiseizure medication
- Primary outcome
- Seizure recurrence after withdrawal by seizure-free period
- Effect
- Under 5 years RR 1.49 (1.17 to 1.88); children under 3 years RR 1.70 (1.20 to 2.39)
This meta-analysis pooled studies of people with epilepsy who stopped antiseizure medication and compared relapse by how long they had been seizure-free beforehand.
Shorter seizure-free periods were associated with more relapse. Across all ages the threshold was five years; in the paediatric subgroup, three years. Results also varied by region.
The included studies differ in design, and the subgroup estimates are less certain than the overall result. Withdrawal decisions still depend on the epilepsy syndrome and EEG, and on what a relapse would mean for the child and family.
- Across all ages, under five years seizure-free carried about 1.5 times the relapse risk.
- In children, under three years seizure-free carried about 1.7 times the risk.
- Epilepsy syndrome, EEG and imaging still shape the decision.
- Taper gradually and give a written seizure plan during withdrawal.
- Discuss driving, school and safety implications before tapering in adolescents.
Why it matters
Families often ask to stop after two years, the traditional minimum, and this analysis suggests waiting longer may matter for children.
Don't overread it
The paediatric figure is a subgroup estimate from mostly observational studies.
The statistics, in plain English
A relative risk of 1.70 means about 70% more relapses. The intervals do not cross 1, but subgroup estimates are less reliable than the overall figure.
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