Discontinuation of antiseizure medication in patients with epilepsy

Abstract

Approximately two thirds of patients with epilepsy become seizure-free with antiseizure medication (ASM). Acentral question is whether and when ASM can be discontinued. To present an overview of the current knowledge about risks and benefits of discontinuation of ASM. Review of the current literature, discussion of data on and recommendations for discontinuation of ASM. The risk of seizure recurrence after discontinuation of ASM is approximately 40-50% and thus twice as high as continuing with ASM. Guidelines recommend considering discontinuation of ASM at earliest after aseizure-free period of 2years. Predictive variables for seizure recurrence after stopping ASM include longer duration of epilepsy and higher number of seizures until remission, ashorter seizure-free interval until stopping ASM, older age at epilepsy onset, developmental delay or IQ < 70, febrile seizures in childhood, absence of aself-limiting epilepsy syndrome, and evidence of epileptiform activity in the electroencephalograph (EEG). The individual risk of seizure recurrence after stopping ASM can be estimated using an online prediction tool. Discontinuation of ASM should be discussed with patients at the earliest after 2years of seizure freedom in ashared decision-making process weighing up the risks and benefits. The risk of aseizure recurrence depends on anumber of clinical variables. Psychosocial aspects, such as impact on driving and occupational issues must be taken into consideration as well as individual fears and concerns of patients about seizure recurrence or the long-term use of ASM.