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Special concerns on taking Anti-epileptic Drugs

 

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When to stop taking AED?

When a person on AED has no more seizure attack for 2 or more years, withdrawal of AED can be considered although the danger of recurrence is always present. Risk of relapse within 2 years of starting to withdraw treatment is two or three times greater than that in continued treatment (10% per annum). The risk of seizure recurrence decreases as the length of the seizure free period increases e.g. 5 years or more. Considering these points, the benefits of stopping AED should outweigh the consequences of seizure recurrence such as in the cases of young women contemplating pregnancy. The decision of stopping AED lies in the person taking it because social factors such as the possession of a driving license and the need to work are often of greater importance. The person's attitude to prolonged therapy as well as fear of seizure recurrence should also be taken into account by the physician. For a polytherapy, only one drug should be withdrawn at a time.

According to evidence in literature, experts support recommendation to consider AED withdrawal in the following patients (includes both adult and children):

Discontinue may be appropriate in people not meeting the above criteria although the risk of recurrence maybe higher than 31.2% in children and 39% in adults.

 

Factors which increased the risk of seizure recurrence in drug withdrawal group:

  1. Age 16 and over
  2. Taking more than one AED
  3. History of seizures after starting treatment
  4. History of tonic-clonic seizures (primary or secondary)
  5. History of myoclonic seizures
  6. History of neonatal seizures
  7. Duration of treatment for ten or more years
  8. An abnormal EEG in the previous year.

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Drug therapy, Surgery, Alternative methods

 

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