17. When and How to Stop Antiepileptic Drugs

  1. John W. Miller MD, PhD Director, UW Regional Epilepsy Center, Professor of Neurology and Neurological Surgery2 and
  2. Howard P. Goodkin MD, PhD The Shure Professor of Neurology and Pediatrics, Director, Division of Pediatric Neurology3
  1. John D. Hixson

Published Online: 10 JAN 2014

DOI: 10.1002/9781118456989.ch17

Epilepsy

Epilepsy

How to Cite

Hixson, J. D. (2014) When and How to Stop Antiepileptic Drugs, in Epilepsy (eds J. W. Miller and H. P. Goodkin), John Wiley & Sons, Oxford. doi: 10.1002/9781118456989.ch17

Editor Information

  1. 2

    University of Washington, Seattle, WA, USA

  2. 3

    Department of Neurology, University of Virginia, Charlottesville, VA, USA

Author Information

  1. Department of Neurology, University of California San Francisco, San Francisco, CA, USA

Publication History

  1. Published Online: 10 JAN 2014
  2. Published Print: 14 FEB 2014

ISBN Information

Print ISBN: 9781118456941

Online ISBN: 9781118456989

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Keywords:

  • epilepsy;
  • AED ;
  • discontinuation;
  • withdrawal;
  • relapse;
  • risks;
  • seizure recurrence;
  • seizure control

Summary

When an epilepsy patient achieves seizure freedom, there are immediately questions about the length of time that the individual must remain on antiepileptic medications. Often, the bias to continue therapy results in a prolonged exposure to these medications, even when there is reasonable evidence to attempt a withdrawal trial. Seizure recurrence rates can be two to three times higher in patients who attempt a medication withdrawal, but there are long-term benefits that may warrant this heightened risk. In general, patients who experience seizure freedom for a prolonged period of time (1–2 years in children; 2–5 years in adults) can be counseled about the possibility of an antiepileptic drugs (AED) withdrawal trial. Factors implying a higher risk for seizure recurrence include abnormal neurologic exam, abnormal imaging finding, abnormal epileptiform pattern on electroencephalogram (EEG), longer duration of epilepsy, and history of medication resistance.