Summary
Most patients with epilepsy will become seizure-free on antiepileptic drugs (AEDs) within a few years of diagnosis. More than 60% will remain so when the medication is withdrawn. After assessing the risks and benefits for the individual patient, withdrawal may be considered by the physician and informed patient or parent if the patient meets the following profile: normal neurological examination, normal IQ, normal electroencephalogram (EEG) prior to withdrawal, seizure-free for 2 to 5 years or longer, and no juvenile myoclonic epilepsy. AEDs can be safely withdrawn in seizure-free patients over the course of 6 months, possibly even faster, especially in children.
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References
de Silva M, MacArdie B, McGowan M, et al. Randomised comparative monotherapy trial of phenobarbitone, phenytoin, carbamazepine, or sodium valproate for newly diagnosed childhood epilepsy. Lancet 1996; 347: 709–13
Cockerell OC, Johnson AL, Sander JWAS, et al. Remission of epilepsy: results from the National General Practice Study of Epilepsy. Lancet 1995; 346: 140–4
Shinnar S, Berg AT, Moshé SL, et al. Discontinuing antiepileptic drugs in children with epilepsy: a prospective study. Ann Neurol 1994; 35: 534–45
Medical Research Council Antiepileptic Drug Withdrawal Study Group. Randomised study of antiepileptic drug withdrawal in patients in remission. Lancet 1991; 337: 1175–80
Dean JC, Penry JK. General principles: discontinuation of antiepileptic drugs. In: Levy R, Mattson R, Meldrum B, et al., editors. Antiepileptic drugs. 4th ed. New York: Raven Press, 1995: 201–8
Gross-Tsur V, Shinnar S. Discontinuing antiepileptic drug treatment. In: Wyllie E, editor. Treatment of epilepsy: principles and practice. Philadelphia: Lea & Febiger, 1993: 858–66
Berg AT, Shinnar SMD. Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology 1994; 44: 601–8
Overweg I. Withdrawal of antiepileptic drugs in seizure-free adult patients: prediction of outcome. Amsterdam: Rodopi, 1985: 174–5
Maytal J, Shinnar S, Moshe SL, et al. The low morbidity and mortality of status epilepticus in children. Pediatrics 1989; 83: 323–31
Aldenkamp AP, Alpherts WCJ, Blennow G, et al. Withdrawal of antiepileptic medication in children — effects on cognitive function: the multicenter Holmfrid study. Neurology 1993; 43: 41–50
Todt H. Risk of relapse after discontinuation of antiepileptic drug therapy: results of a new prospective follow-up study [abstract]. Epilepsia 1993: 34 Suppl. 2: 7
Janz D, Christe W. Generalized epilepsies. In: Resor SR, Kutt H, editors. The medical treatment of epilepsy. New York: Dekker, 1992: 145–62
Schmidt D. Anticonvulsants. In: Dukes MNG, editor. Meyler’s side effects of drugs. 12th ed. Amsterdam: Elsevier, 1992: 122–43
Jacoby A, Johnson A, Chadwick D. Psychosocial outcomes of antiepileptic drug discontinuation. Epilepsia 1992; 33(6): 1123–31
Subcommittee of the American Academy of Neurology. Discontinuing antiepileptic drugs in seizure-free patients: a guideline. World Neurol 1995; 10: No. 3/4
Schmidt D. Suppression complète ou partielle des médicaments antiépileptiques. Rev Neurol 1987; 143(5): 429–36
Tennison M, Greenwood R, Lewis D, et al. Discontinuing antiepileptic drugs in children with epilepsy: a comparison of a six-week and a nine-month taper period. N Engl J Med 1994 May 19; 330: 1407–10
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Schmidt, D., Gram, L. A Practical Guide to When (and How) to Withdraw Antiepileptic Drugs in Seizure-Free Patients. Drugs 52, 870–874 (1996). https://doi.org/10.2165/00003495-199652060-00008
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DOI: https://doi.org/10.2165/00003495-199652060-00008