When do you consider stopping anti-seizure medications in seizure-free pediatric epilepsy patients?

Prior to 1988, we would never dare take a patient off seizure medicine if the patient was seizure-free.

Callaghan's paper published in the New England Journal of Medicine (Callaghan et al., PMID 3127710) clearly showed that patients who were seizure-free on Tegretol for 3 years had a 90% chance of be...

The risk of recurrence of seizures in the pediatric population after 2-4 years is low compared to adults especially if no risk factors and EEG and MRI are normal.

This is a very good article to refer to by Gloss et al. PMID 34873018.

My general answer would be following 2 years of seizure freedom and a recent EEG demonstrating no or rare epileptiform activity. However, I'm not certain a blanket statement can be made, as underlying pathology plays a huge role, as do the results of EEG and MRI. For example, a child with a variant ...