Variation in seizure risk increase from antiseizure medication withdrawal among patients with well-controlled epilepsy: a pooled analysis.

No single patient factor significantly modified the influence of discontinuation on seizure risk, though we captured how absolute risk increases change for patients that are at low- versus high-risk. Patients should likely continue ASMs if even a 7% two-year increase in the chance of any more seizures would be too much and should likely discontinue ASMs if even a 37% risk increase would be too little. In between these extremes, individualized risk calculation and a careful understanding of patient preferences are critical. Future work will further develop a two-armed individualized seizure risk calculator and contextualize seizure risk thresholds below which to consider discontinuation.