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
- 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 127.0.0.1