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Epilepsy - Stopping Anti-Seizure Medication

Anticonvulsants may not be Necessary After Successful Drug Therapy

Mar 8, 2009 Zoe Langley

People who become seizure free while using antiepileptic drugs may no longer need anticonvulsants and most doctors will agree to discontinue the medication.

Many people do achieve good seizure control with drugs. After a long period of being seizure free, some people can stop taking anti-seizure medications.

When and Why to Discontinue Anti-convulsants

Most doctors require that a patient be free of seizures for two or more years before withdrawing anti-convulsants. There are three major reasons to consider stopping anti-seizure medication when seizures are well controlled. These include the cost of the medication and the necessary monitoring and doctor visits when they may no longer be necessary.

Side effects of the medications are another reason it may be advisable to withdraw from anticonvulsants. These may include cognitive impairment, metabolic disorders, liver problems, and bone disorders.

Many Could Stop Medication

Not everyone with a seizure disorder controlled by drugs can safely stop taking medication. According to Mayo Clinic, "The major risk of discontinuing medication is recurrence of seizures. However, studies suggest that more than half of adults with epilepsy who have not had a seizure in two years could stop taking medication without having another seizure" (Mayo Clinic Staff, 9/17/07, AN01690).

High Risk and Low Risk Factors for Stopping Anticonvulsants

Stopping anti-seizure medication can be considered for those patients who have the least risk of recurring seizures. Writing for Medscape, Margaret A. Fitzgerald, MS, APRN, BC, NP-C, FAANP, discusses the risks of having seizures if medication stopped. Fitzgerald notes the following low and high risk factors for stopping anti-convulsants:

Low Risk High Risk

Normal EEG Nervous System Disorder
Drug Monotherapy Tumor, scarring, head injury
Idiopathic seizures Abnormal EEG

A doctor might also consider withdrawing anti-seizure medication in six months to a year for someone who has had only a single seizure (Schacter).

Withdraw From Drugs Slowly

Withdrawing from anti-convulsants requires careful planning between the doctor and the patient. Writing in A Guide to Understanding and Living with Epilepsy, Dr. Orrin Devinsky says that often medication can be reduced a little at a time as it is discontinued.

It is never safe to just stop taking a seizure medication. Doing so will increase the chances of having a seizure or triggering non-stop seizures (status epilepticus).

Reduce the Risks of Having Seizures

The same principles for minimizing the risks of having a seizure while taking drugs apply to strategies to use when withdrawing from medications and after they have been discontinued. Avoiding common seizure triggers will optimize the chances of successful anti-convulsant withdrawal.

Some of these are:

Poor, or too little sleep
Alcohol
Caffeine

Drugs, Herbs, and Supplements (Prescription and over-the-counter): Pharmacist s often can advise if a drug, herb, or supplement might lower the seizure threshold or interact dangerously with anything else being taken.

Withdrawing Children From Anti-convulsants

Children who have not had many seizures, whose seizures have no known cause, or who responded well to medication are most likely to remain seizure free after medication is discontinued. According to the Epilepsy Foundation, 40 to 60% of the lower risk children will remain seizure free. The Foundation also notes that 80% of the seizure recurrences will take place within the first five years of medication withdrawal.

Resources:

Epilepsy Foundation

Epilepsy.com

Sources:

Devinsky, Orrin, MD, A Guide to Understanding and Living With Epilepsy, pp112-114, FA Davis Co., Philadelphia, 1994

Epilepsy Foundation of America, Discontinuing Antiepileptic Drugs, epilepsyfoundation.org

Fitzgerald, M A, MS, APRN, BC, NP-C, FAANP; What Do I Need to Know About Discontinuing Antiepileptic Drug Therapy for a Patient Who Has Been Seizure-Free?; Medscape Nurses 2005;7 (2); Medscape

Mayo Clinic Staff; Anti-Seizure Medications: Can I Stop Taking Them?; AN01690, Sep 17, 2007, mayoclinic.com

Schachter, Steven C, MD, (ed.), Starting and Stopping Medication, epilepsy.com, 12/15/06

The copyright of the article Epilepsy - Stopping Anti-Seizure Medication in General Medicine is owned by Zoe Langley. Permission to republish Epilepsy - Stopping Anti-Seizure Medication in print or online must be granted by the author in writing.

Successful therapy may make drugs unnecessary