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Withdrawal of antiepileptic drugs in seizure-free patients: chance or jeopardy?

Nature Clinical Practice Neurology volume 4, pages 598–599 (2008)Cite this article

Seizure freedom is the goal of epilepsy treatment. Several studies confirm that the probability of achieving remission in patients with epilepsy is 70–75%;1 about 60% of previously untreated patients become seizure-free on monotherapy.2 Discontinuation of antiepileptic drug (AED) treatment might be a valuable option in patients who have been seizure-free for 2 years. Discontinuation is usually based on the occurrence (or risk) of AED adverse effects, which are reported in up to 50% of patients on long-term treatment. AED withdrawal is a controversial decision, however—high probability of relapse with all its consequences is the main concern.

Overall, withdrawal of medication is reasonable when a disease is cured or, at least, when the underlying process is suppressed to a substantial degree so that life-time (or close to that) remission can be guaranteed. According to the proposal by the International League Against Epilepsy (ILAE), “epilepsy is...characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences.”3 Truly antiepileptogenic drugs that address this enduring predisposition are needed to increase the chances of remaining seizure-free after discontinuation of treatment. In spite of some promising signals from experimental research, however, there is no clinical evidence that either traditional or new AEDs alter the underlying epileptogenic process; thus, such agents are antiseizure but not antiepileptogenic.

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  1. Department of Neurology and Neurosurgery, Russian State Medical University, Leninsky Prospect 8/8, 117049 Moscow, Russia a.shpak@g23.relcom.ru

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  1. AB Guekht is Professor of Neurology in the Department of Neurology and Neurosurgery, Russian State Medical University, Moscow, Russia.,

    Alla B Guekht

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  1. Alla B Guekht
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Guekht, A. Withdrawal of antiepileptic drugs in seizure-free patients: chance or jeopardy?. Nat Rev Neurol 4, 598–599 (2008). https://doi.org/10.1038/ncpneuro0937

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