Clinical guide: discontinuing chronic antiepileptic drug treatment

Abstract

The decision to continue or withdraw the antiepileptic drugs (AEDs) should be taken jointly by the patient, family and/or caregivers, and the specialist physician, after extensive information and discussion about the risks and benefits of withdrawing the AED. The patient and family members must understand that there is a risk of the recurrence of seizures with and without AED. The type of epilepsy, the prognosis, and the patient's lifestyle should be taken into account. Withdrawal should be carried out under the supervision of a specialist (clinical neurologist) and will be considered when the patient has been seizure free for at least 2 years. The treatment must be withdrawn gradually for a period of at least 2-3 months and the antiepileptics must be removed one by one. Withdrawal of benzodiazepines and barbiturates should be slower, in 6 months or more. An agreement must be made that in the event of a seizure relapse, the patient must return to taking the last dose before the dose in which the relapse was presented and request assessment by clinical neurologist.