title: AED discontinuation may be dangerous for seizure-free patients.
abstract: Despite its benefits, stopping antiepileptic drugs (AEDs) in seizure-free patients is associated with several risks. AED discontinuation doubles the risk of seizure recurrence for up to 2 years compared with continued treatment. On average, one in three patients has a seizure recurrence, though the range can go up to 66% (34%, range 12-66%, 95% CI: 27-43). Furthermore, the outcome of treating a seizure recurrence in patients who have been seizure-free for years is surprisingly poor in some patients. Although the long-term prognosis is not worsened by drug discontinuation, one in five patients does not re-enter remission and for some patients, it may take several years to become seizure-free again. The risk of seizure recurrence is particularly high for those with juvenile myoclonic epilepsy and symptomatic focal epilepsy, the most frequent epilepsies in adults. Seizure-recurrence may have devastating, medical, psychological and social consequences for the individual, for example injury, loss of self-esteem, unemployment and losing a driver's license. Discontinuation should be avoided in patients with a high risk of seizure recurrence. Given these risks, patients will ultimately have to decide themselves whether they wish to discontinue drug treatment after full informed consent.
authors.affiliation: Epilepsy Research Group, Goethestr. 5, 14163, Berlin, Germany. dbschmidt@t-online.de
authors.forename: Dieter
authors.initials: D
authors.lastname: Schmidt
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage*; D004827:Epilepsy / Q000188:drug therapy; D006801:Humans; D012307:Risk Factors; D055502:Secondary Prevention; D012640:Seizures / Q000517:prevention & control*
chemical_list: D000927:Anticonvulsants