Calculating the individualized risks of AED withdrawal for medically treated patients

Introduction: Withdrawal of antiepileptic drugs (AEDs) may be considered in seizure free epileptic patients; those who become completely AED free have a better quality of life,but the risk of seizure recurrence may be a deterrent factor for AED discontinuation. Background: Previous studies have shown that recurrence risks after AED withdrawal is about 22% at one year, 28% at two years, and 34% at three or four years, respectively .In these patient after restarting AED, 80% will become seizure free ,but in 20% of the remaining patients, the seizures will not be controlled again, so application of special criteria ,nomograms and tools are clinically essential. Discussion :Systematic review of the available data have identified that 25 variables can significantly predict the seizure recurrence in these patients .However, factors determining seizure outcome have not been discussed properly ;Moreover, the methods, population ,designs and other characteristics of the studies are not similar; So, the strongest predictors of seizure recurrence cannot be identified accurately; The effects of combinations of the these variables are also not predictable for an individual patient A meta-analysis of 1769 patients with individual participant data (IPD) has identified the independent predictors of seizure relapse and eventual seizure freedom following AED discontinuation .So, at the present time, we will be able to calculate the individualized outcome risks .The proposed nomograms and tools are validated across different populations and may be useful in all medically treated children and adults in whom AED discontinuation is considered. Conclusion: using the proposed nomograms and tools which will be discussed in this presentation will improved the quality of our clinical practice and help us to determine the outcome risks of AED withdrawal with respect to the latest evidence-based estimates.