LAUSR

Withdrawal of anti‐seizure medication (ASM) is challenging, especially in patients with recurrent seizures. Only limited evidence exists regarding the success rate and recurrence risk factors after withdrawal of ASM for a second time in patients with pediatric‐onset epilepsy. In this observational study, we evaluated 104 patients with recurrent pediatric‐onset epilepsy who had ASM withdrawn for a second time. The success rate was 41.3% after the second withdrawal of ASM. The absence of a self‐limiting epilepsy syndrome, shorter seizure‐free intervals before the second withdrawal of ASM, and relapse during tapering after the initial withdrawal of ASM were negative factors significantly associated with the success of ASM withdrawal for a second time. Even after a second seizure recurrence, all patients eventually became seizure‐free after restarting their previous ASM (78.7%) or readjusting the ASM (21.3%). Our findings that 40% of patients with recurrent pediatric‐onset epilepsy could achieve long‐term seizure freedom and that all patients with a second seizure recurrence remained seizure‐free suggest that ASM may be withdrawn for a second time after carefully stratifying clinical risk.