Discontinuation of AEDs: When and how?

Once a patient has initiated an antiepileptic drug (AED) and achieved a sustained period of seizure freedom, the decision to discontinue AED should be balanced against continuation of AED therapy indefinitely. Studies show that the rate of seizure recurrence after AED withdrawal is about two to three times the rate in patients who continue AEDs. However, there are many benefits to AED withdrawal that should be evaluated on an individualized basis. AED discontinuation may be considered in patients whose seizures have been completely controlled for a prolonged period. There are several factors that would increase risk of recurrences which will be reviewed and discussed. As a consequence, the decision to withdraw or withhold treatment must be still individualized. In any patient, the decision to discontinue treatment should also take into effect the social aspects like driving license, job and leisure activities as well as emotional and personal factors and patients with adverse effects or drug interactions. Patients will ultimately have to decide themselves whether they wish to discontinue drug treatment.