Cochrane for Clinicians: When to Discontinue Antiepileptic Drug Therapy for Patients in Remission

Furthermore, some patients may have had nonepileptic (psychogenic) seizures or seizures provoked by a resolved stimulus (e.g., fever, alcohol or drug withdrawal).1 The authors of this Cochrane review assessed the risk of discontinuing antiepileptic drug therapy in children and adults with true epilepsy. The authors searched for randomized controlled trials comparing patients with epilepsy who underwent early (less than two continuous years seizure-free) vs. late (two or more years seizure-free) withdrawal of antiepileptic drugs. In 1994, the American Academy of Neurology published guidelines recommending discontinuation of antiepileptic drug therapy if the following criteria are met: seizure-free for two to five years, only one type of epilepsy, normal EEG findings, and normal neurologic examination findings.2 The Italian League Against Epilepsy recommends a minimum of two years seizure-free and tapering of antiepileptic drugs over at least six months.3 A 2010 review of randomized and nonrandomized trials addressed risk factors affecting the prognosis after discontinuing medication.4 The author concluded that sudden death and development of a treatment-refractory, resistant form of epilepsy are rare and should not be emphasized in the shared decision-making process.