When is it safe to discontinue AED treatment?
When people with epilepsy become seizure-free with daily antiepileptic drug (AED) management, there is a very individual decision to be made about discontinuing this treatment. After 1-6 years of seizure-freedom, it is estimated that 69% of children and 61% of adults remain seizure-free when AEDs are tapered and stopped. The length of time that a patient is seizure-free does not influence the success rate in children but may in adults. The epilepsy syndrome does not seem to influence the chance of success in 75% of children; however, several prediction schemes based on risk factors for recurrence may be useful. There are two major risks in discontinuing treatment--a tiny risk that the epilepsy will not be controlled again and a tiny risk of death during a recurrence. Children who have had 1-2 years seizure-free deserve a chance to discontinue their AED treatment, whereas in adults this decision probably should wait until there have been at least 4 years of seizure-freedom.
Camfield
Peter
P
Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada. camfield@dal.ca
Camfield
Carol
C
D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage*; D002648:Child; D004827:Epilepsy / Q000188:drug therapy*; D006801:Humans; D055502:Secondary Prevention; D012640:Seizures / Q000517:prevention & control*; D013995:Time
D000927:Anticonvulsants