Prognostic implications of persistent interictal epileptiform discharges on antiseizure medication withdrawal in patients with epilepsy in five-year remission

•For the five-year-remission epilepsy patients with persistent IEDs, drug withdrawal might be a rational choice for the individualized assessment of benefits and risks.•ASM withdrawal was not found to be an independent risk factor for seizure recurrence.•Patients with structural-metabolic or unknown etiology, and multiple seizure types were at a higher risk of recurrence, requiring careful tapering off of medication after comprehensive consideration of seizure severity.•Most five-year-remission epilepsy patients with persistent IEDs relapsing after ASM withdrawal could achieve seizure remission again after ASM retreatment.