Treatment
Children
➤ In children who are seizure-free for at least 18–24 months, who do not
have an electroclinical syndrome suggesting otherwise, there should
be a discussion about the risks and benefits of ASM withdrawal that
specifically includes and documents that if seizures recur during either
withdrawal or after withdrawal, there is a small chance they will no longer
respond to medication (Level B).
➤ Clinicians should discuss with children and their families that ASM
withdrawal can be considered because withdrawal of ASMs does not
clearly increase risk of seizure recurrence (Level B).
➤ Clinicians should counsel that recurrent seizures put children at risk
for status epilepticus and death (Level B), although existing data do
not suggest an increased risk of status epilepticus or death after ASM
withdrawal.
➤ Clinicians should explore contributors to quality of life for individual
patients as part of shared decision-making regarding ASM withdrawal
(Level B).
➤ In children seizure-free for at least 18–24 months, if there is agreement
between the physician, patient, and family to pursue consideration of ASM
withdrawal, an EEG should be ordered (Level B).
➤ In children seizure-free for at least 18–24 months, in whom there
is agreement between the physician, patient, and family to pursue
consideration of ASM withdrawal, if the EEG does not show epileptiform
activity, ASM withdrawal should be offered, at a rate no faster than 25%
every 10–14 days (Level B).
➤ Clinicians must take into account the known natural history of the specific
electroclinical syndrome when counseling about ASM withdrawal in
children (Level A [no low to moderate risk of bias evidence]).
