[Our Experience with Pediatric Patients Withdrawn from Pharmacological Treatment for Epilepsy who Remain Untreated].

introductionThere are many variables to consider when withdrawing anti-epileptic seizure treatment and risk-benefit evaluation is required. MATERIAL AND

methodsRetrospective study of patients from a neuropediatric clinic who were discontinued from pharmacological treatment for epilepsy and continued without treatment.

resultsOf 57 children from whom treatment was withdrawn, 34 remained without treatment. In 23 cases, treatment was withdrawn once, with a mean seizure-free time until withdrawal of 21 months and a mean age of 10.5 years. Three cases presented seizures but treatment was not reintroduced; the average time without a crisis was 44.78 months. Treatment was withdrawn twice in nine children and three times in two children, with a mean seizure-free time until withdrawal of 28.5 months; the average age was 16.3 years. Two cases presented seizures but treatment was not reintroduced; the average time without a crisis was 5.7 years. High-risk cases of recurrent epileptic seizures were left without anti-seizure medication: seven cases of intellectual disability, one refractory epilepsy, two cases of epilepsy with onset in adolescence, and in 11 children, 13 instances of failure in previous withdrawal attempts. DISCUSSION: The indication and maintenance of treatment with anti-seizure drugs in children must prioritize patient welfare and be based on three premises: the treatment is indicated, the treatment is tolerated, and the treatment is effective. The decision to withdraw must be made on a case-by-case basis, acknowledging the risk of relapse and taking into account efficacy and tolerance, especially in children with behavioral and neurodevelopmental disorders.