The present report evaluates the suppression of antiepileptic drugs in a group of 608 epileptics. Conditions for the suppression of antiepileptic treatment included a previous seizure-free period of 5 years under medication, and a careful evaluation of individual social and work-related circumstances. The reduction of medication was realized during a minimum period of 1 year, passing from eventual polytherapy to monotherapy. Of the total 608 epileptics in whom treatment was suppressed, 144 relapses (23.7%) occurred, and 464 (76.3%) patients continued to be seizure-free. A complete remission of the epilepsy was achieved in 14.3% of 3,254 epileptics with an adequate follow-up. Significant risk factors for recurrence included a delay in starting anticonvulsant therapy; symptomatic generalized epilepsy; different types of combined seizures, or atypical absences and/or tonic crisis and/or atonic crisis; or partial complex associated with secondary generalized tonic-clonic seizures; the presence of status epilepticus in the course of the disease and permanent neurologic damage. With the patient’s prior agreement, it was possible to suppress anticonvulsant medication in one fourth of nonselected epileptic patients with a possibility of relapse in about 25% of the cases (generally one isolated seizure).

La historia del síndrome de Lennox-Gastaut debe tomar su punto de partida en los primeros tiempos de la EEG clínica, y específicamente en los trabajos iniciales de los esposos Gibbs y de Lennox en el año 1939 13 en que diferencian dos tipos de punta-onda: la punta-onda rápida a 3 c.s. de caracter rítmico, de distribuición bilateral, síncrona, frecuentemente crítica y fácil de provocar mediante la hiperpnea; la punta-onda lenta alrededor de 2 c.s. mucho menos sistematizada en su distribuición, de caracter rara vez rítmico, que no suele acompañarse de manifestaciónes clínicas y cuya sensibilidad a los cambios de CO 2 y de glucosa en sangre es mucho menor. Corresponde a Lennox y Davis, en 195019 , el mérito de haber establecido correlaciones entre la punta-onda lenta y las manifestaciones clínicas. Lennox señala, en 1960 18 que los enfermos con punta-onda lenta no tienen una historia familiar de epilepsia, las crisis se inician en edades tempranas de la vida, suelen presentar signos evidentes de lesión cerebral y son oligo¬ frénicos más o menos importantes. También Lennox señala que el EEG muestra una actividad de fondo enlentecida y que el pronostico de estos casos es francamente malo, tanto por lo que respecta al futuro intelectual de los enfermos, como por la resistencia de las crisis a las medicaciones conocidas.En las décadas de los años 40 y 50 y en la primera mitad de los 60, si bien la punta-onda rápida y su expressión clínica, la ausencia típica, es objeto de numerosos trabajos, la punta-onda lenta queda en el olvido de la Relatório presentado al V Congresso Brasileño de Neurologia (São Paulo 12-15 de julho, 1972).

A review of a series of epileptic patients revealed the importance of the ‘lost time’ in the future time course of a patient. The ‘lost time’ is regarded as the period of time elapsed since the onset of symptoms and the implementation of adequate treatment. An assessment of the follow-up of 3,529 epileptic patients showed that the shorter the ‘lost time’, the greater the efficacy of anticonvulsant treatment. Even the incidence of relapses after discontinuation of antiepileptic drugs correlates with the ‘lost time’ before diagnosis. These findings emphasize the importance of establishing an early diagnosis of the type of epilepsy and the prescription of adequate antiepileptic medication.

We reviewed records of 5,000 epileptic patients and identified 154 cases of partial epilepsy with seizure onset in the first 3 years of life. Of these, 35 patients had initial partial seizures. In 57 patients, partial seizures were preceded by a hemiclonic seizure, which manifested as status epilepticus in 70%. Generalized seizures were the initial manifestation in 62 patients: 17 grand mal, 14 clonic or myoclonic, and 31 tonic or atonic seizures. Of the 119 patients, 31 showed a seizure free-interval of several years between the initial seizure and the occurrence of partial epilepsy. The atypical initial clinical presentation and the seizure-free interval before occurrence of more characteristic partial seizures raise the possibility that the diagnosis of partial epilepsies in the first years of life may be missed.

SUMMARY The aim of this survey was to define the criteria for eliminating medication. In the first place the patient should not have had a seizure for 10 years. So long a period may seem excessive to some, but we believe that this study demonstrates that it is not too long; even after 10 years without seizures, several patients experienced them again when medication was stopped. As to absences, it is doubtlessly unnecessary to continue anti‐petit mal medication in many patients, but in all cases it is necessary to continue treatment to prevent possible generalized seizures. We propose the following considerations in each case: the clinical‐EEG form of the epilepsy; the number of seizures suffered by the patient, absence of repeated seizures or status and early initiation of medication; absence of permanent neurological or mental deficit; negative family history of seizures; absence of other antecedents, especially in the partial epilepsies (traumatic antecedent of epilepsy, however, is generally of good prognosis); absence of paroxysmal EEG abnormalities or prompt normalization of the EEG with medication (persistent focal activity does not however contraindicate eliminating medication when there have been no seizures). Abrupt elimination of medication is contra‐indicated; medication should be reduced slowly, generally over a period of more than 1 year. An increase in EEG abnormalities on reduction of medication makes a return to previous doses obligatory. Using these criteria, we have been able to eliminate medication in nearly half our patients. It is of course possible that some of them may have new seizures; according to Juul‐Jensen (1968), seizures may reappear as long as 5 years after medication has been stopped.