• Anticonvulsants
• Withdrawal
• Online Calculator

It is often challenging to predict the risk of seizure recurrence after withdrawal of antiepileptic medication in people with epilepsy who are currently seizure free. One can obtain a quantified estimate of such risk using the ‘prognostic index for recurrence of seizures within one and two years after continuing antiepileptic drug treatment or starting slow withdrawal,’ derived from results of the 1991 ‘Medical Research Council study for antiepileptic drug withdrawal.’1 Until recently I would manually enter all information required by this prognostic index into a Microsoft Excel table that I had personally created to calculate the risk of seizure recurrence after stopping antiepileptic medication.

However, there is now a similar tool, more up to date and reliable, available online at: http://epilepsypredictiontools.info/

The ‘Antiepileptic Drug Withdrawal Risk Calculator,’ developed by UMC Utrecht-Brain Center Rudolf Magnus and by Epilepsiefonds, is a free online tool that allows physicians to calculate individualised risks of seizure recurrence and long-term outcomes in seizure-free patients with epilepsy in whom withdrawal of antiepileptic medication can be considered. This calculator uses a prognostic model derived from an individual patient data meta-analysis that was subsequently validated in 10 different populations of children and adults.2 This prognostic model is expressed in a nomogram that may be used to calculate the individualised chance of seizure recurrence at 2 and 5 years of follow-up for each patient stopping antiepileptic medication (figure 1). To simplify their use in daily practice, the nomogram has been translated into the online ‘Antiepileptic Drug Withdrawal Risk Calculator.’ The calculator is extremely easy to use: the clinician needs only to enter the required information in the fields, and then press ‘calculate’ to obtain the overall risk of seizure recurrence (figure 2). The calculator provides information on risk of seizure recurrence in the first 2 and 5 years following antiepileptic medication withdrawal, and on the chance of seizure freedom at 10 years after stopping the antiepileptic medication. Of note, this tool cannot be applied to patients with epilepsy who become seizure free after epilepsy surgery and who still take antiepileptic medication.

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Figure 1

Nomogram to predict seizure recurrence after antiepileptic drug withdrawal. EEG, electroencephalogram (reprinted from Lamberink et al [2], with permission from Elsevier).

Needless to say, since the appearance of the online ‘Antiepileptic Drug Withdrawal Risk Calculator,’ I have abandoned the use of my old dear Excel table in my daily practice.

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