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Withdrawal of anticonvulsant Rx

Withdrawal of anti-epileptic drugs in seizure-free adults:

Factors predicting seizure recurrence following antiepileptic drug withdrawal:

associated with increased risk:
  • juvenile myoclonic epilepsy - esp. if sleep deprivation or excess alcohol; responds well to valproate;
  • partial seizures with secondary generalisation - often resistant to antiepileptic drug Rx.
  • abnormal EEG
  • epileptogenic lesion on neuroimaging
associated with decreased risk:
  • childhood absence epilepsy - often remits in adult life
  • benign rolandic epilepsy - often sleep-related; respond well to carbamazepine;
  • normal EEG
  • normal neuroimaging
  • onset in childhood
  • no seizures for more than 2yrs prior to antiepileptic drug withdrawal
  • monotherapy
  • no seizures following introduction of antiepileptic drug
  • normal intellect

suggested protocol of withdrawal:

  • consider withdrawing after 2yrs seizure free in children and 3 years in adults if low risk for recurrence

inform patient of seizure risk, and this risk is greatest in 1st 12months of withdrawal.

  • should not drive for full period of withdrawal and for 3 months thereafter unless experienced consultant feels seizure risk is low.
  • reinforce usual seizure safety - eg. not swimming alone; avoid heights; shower instead of bathing;
  • avoid factors that provoke seizures - sleep deprivation, alcohol, drugs, etc.
  • if on multiple drugs, withdraw one at a time
  • withdrawal should be gradual over 6 mths, thus unless low dose, decrease daily dose every 4 weeks by:
  • ref: Australian Prescriber vol27:5 Oct 2004
seizures_withdrawingrx.txt · Last modified: 2008/09/25 08:37 by

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