Withdrawal of antiseizure medications in patients who are seizure-free

Abstract

Objective: To evaluate the demographic data and resolved-relapse rates in clinical follow-up of patients whose antiseizure medications (ASM) were discontinued after a minimum of 2 years of seizure freedom.

Methods: The files of 1985 patients followed in the epilepsy outpatient clinic were evaluated retrospectively. The inclusion criteria for patients were between 18 and 65 years old, followed up at an epilepsy outpatient clinic, and having discontinued ASM after at least 2 years of seizure freedom under the supervision of a neurologist.

Results: A total of 56 patients were included in the study. The age of onset of seizures was 13.9±10.04 years, the age of onset of ASM was 15.87±9.69 years, and the age of quitting ASM was 24.58±11.54 years. The patients had a mean seizure-free period of 64.46±32.27 months before drug discontinuation and 43.73±38.87 months after drug discontinuation. The EEGs of 49 patients were normal in the EEGs performed after drug discontinuation, and seven patients had epileptiform discharges. Relapse was observed in 23.2% of patients after drug discontinuation. It was observed that 69% of the recurrences in 13 patients occurred within the first 2 months.

Conclusion: Although seizure recurrence probability is highest during the first 2 months after ASM discontinuation, it is still possible 6 years later in adults with inactive epilepsy. The time window without seizures before ASM discontinuation and follow-up EEGs afterwards may help in the prediction of seizure recurrence.