Download PDF
CC BY-NC-ND 4.0 · International Journal of Epilepsy 2015; 02(01): 038-043
DOI: 10.1016/j.ijep.2015.03.002
Review Article
Thieme Medical and Scientific Publishers Private Ltd.

Withdrawal of anti-epileptic drugs: A review

Dinkar Kulshreshtha
1   Department of Neurology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP 226010, India
,
Pradeep Kumar Maurya
1   Department of Neurology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP 226010, India
,
Ajai Kumar Singh
1   Department of Neurology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP 226010, India
,
Anup Kumar Thacker
1   Department of Neurology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP 226010, India
› Author Affiliations
Further Information

Publication History

Received: 21 August 2014

Accepted: 11 March 2015

Publication Date:
05 May 2018 (online)

   Permissions and Reprints

Abstract

Anti-epileptic drugs are the mainstay in treatment of epilepsy. It requires a strong clinical decision in patients who are well controlled on medications to withdraw anti-epileptic drugs. This decision has to be based on the clinical profile, epilepsy type, neuroimaging and electroencephalography (EEG) findings and has to be more individualized as per the patient needs. In the context of drug withdrawal, it is necessary to look into the details of why, how and when to withdraw anti-epileptics. In this article, we critically try to answer such queries and look into the established guidelines with respect to drug withdrawal. We shall look into the chances of recurrence on stopping these drugs. Also, in the end we shall discuss briefly some special clinical scenarios where decision to stop anti-epileptic drugs is a challenging task.

Keywords

Epilepsy - Anti-epileptic drug withdrawal - Neurocysticercosis - Epilepsy surgery - Cortical venous sinus thrombosis
 

  • References

  • 1 Kwan Patrick, Brodie MartinJ. Early identification of refractory epilepsy. N Engl J Med 342 2000; 314-319
    CrossrefPubMedGoogle Scholar
  • 2 Peter RCamfield, Carol SCamfield, Renee AShellhaas. Discontinuing Antiepileptic Drugs in Childhood Epilepsy.. Current Management in Child Neurology. 3rd ed.. 148-150
    Google Scholar
  • 3 Kilpatrick ChristineJ. Withdrawal of antiepileptic drugs in seizure-free adults. Aust Prescr 27 2004; 114-117
    CrossrefPubMedGoogle Scholar
  • 4 Das K, Banerjee M, Mondal GP, Devi LG, Singh OP, Mukherjee BB. Evaluation of socio-economic factors causing discontinuation of epilepsy treatment resulting in seizure recurrence: a study in an urban epilepsy clinic in India. Seizure 16 2007; 601-607
    CrossrefPubMedGoogle Scholar
  • 5 Haroon Ahsan, Tripathi Manjari, Khanam R, Vohora Divya. Antiepileptic drugs prescription utilization behavior and direct costs of treatment in a national hospital of India. Ann Indian Acad Neurol 15 2012; 289-293
    CrossrefPubMedGoogle Scholar
  • 6 Nabukenya AnneM, Matovu JosephKB, Wabwire-Mangen Fred, Wanyenze RhodaK, Makumbi Fredrick. Health-related quality of life in epilepsy patients receiving anti-epileptic drugs at National Referral Hospitals in Uganda: a cross-sectional study. Health Qual Life Outcomes 12 2014; 49-56
    CrossrefPubMedGoogle Scholar
  • 7 Lossius MortenIngvar, Hessen Erik, Mowinckel Petter. et al. Consequences of antiepileptic drug withdrawal: a randomized, double-blind study (Akershus Study). Epilepsia 49 2008; 455-463
    CrossrefPubMedGoogle Scholar
  • 8 Medical Research Council Antiepileptic Drug Withdrawal Study Group. Randomised study of antiepileptic drug withdrawal in patients in remission. Lancet 337 1991; 1175-1180
    PubMedGoogle Scholar
  • 9 Mula Marco, Hesdorffer DaleC. Suicidal behavior and antiepileptic drugs in epilepsy: analysis of the emerging evidence. Drug, Healthc Patient Saf 3 2011; 15-20
    CrossrefPubMedGoogle Scholar
  • 10 Andersohn Frank, Schade Rene, Willich StefanN, Garbe Edeltraut. Use of antiepileptic drugs in epilepsy and the risk of self-harm or suicidal behavior. Neurology 75 2010; 335-340
    CrossrefPubMedGoogle Scholar
  • 11 Verma Archana, Misra Surendra. Risk of seizure recurrence after antiepileptic drug withdrawal, an Indian study. Neurol Asia 11 2006; 19-23
    PubMedGoogle Scholar
  • 12 Camfield P, Camfield C. The frequency of intractable seizures after stopping AEDs in seizure-free children with epilepsy. Neurology 64 2005; 973-975
    CrossrefPubMedGoogle Scholar
  • 13 American Academy of Neurology Practice parameter: A guideline for discontinuing antiepileptic drugs in seizure-free patients—summary statement. Neurology 47 1996; 600-602
    CrossrefPubMedGoogle Scholar
  • 14 Olmez Akgun, Arslan Umut, Turanli Guzide, Aysun Sabiha. Risk of recurrence after drug withdrawal in childhood epilepsy. Seizure 18 2009; 251-256
    CrossrefPubMedGoogle Scholar
  • 15 Su L, Di Q, Yu N, Zhang Y. Predictors of relapse after AED withdrawal in seizure free patients with epilepsy. J Clin Neurosci 20 2013; Jun 790-794
    CrossrefPubMedGoogle Scholar
  • 16 Specchio LM, Tramacere L, La Neve A, Beghi E. Discontinuing antiepileptic drugs in patients who are seizure free on monotherapy. J Neurol Neurosurg Psychiatry 72 2002; 22-25
    CrossrefPubMedGoogle Scholar
  • 17 Yadegari Samira, Bahrami Parviz. Traditional versus new antiepileptic drugs. Neurosciences 18 2013; 117-121
    PubMedGoogle Scholar
  • 18 Pavlovic Milen, Jovic Nebojs, Pekmezovic Tatjana. Antiepileptic drugs withdrawal in patients with idiopathic generalized epilepsy. Seizure 20 2011; 520-525
    CrossrefPubMedGoogle Scholar
  • 19 Murakami Miyako, Konishi Tohru, Naganuma Yoshihiro, Hongou Kazuhisa, Yamatani Miwa. Withdrawal of antiepileptic drug treatment in childhood epilepsy: factors related to age. J Neurol Neurosurg Psychiatry 59 1995; 477-481
    CrossrefPubMedGoogle Scholar
  • 20 Pavlou E, Gkampeta A, Evangeliou A, Athanasiadou- Piperopoulou F. Benign epilepsy with centro-temporal spikes (BECTS): relationship between unilateral or bilateral localization of interictal stereotyped focal spikes on EEG and the effectiveness of anti-epileptic medication. Hippokratia 16 2012; 221-224
    PubMedGoogle Scholar
  • 21 Callenbach PetraMC, Bouma PaulAD, Geerts AdaT. et al. Long term outcome of benign childhood epilepsy with centrotemporal spikes: Dutch Study of Epilepsy in Childhood. Seizure 19 2010; 501-506
    CrossrefPubMedGoogle Scholar
  • 22 Berg AT, Shinnar S. Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology 44 1994; 601-608
    CrossrefPubMedGoogle Scholar
  • 23 Tennison M, Greenwood R, Lewis D. et al. Discontinuing antiepileptic drugs in children with epilepsy: a comparison of a six-week and a nine-month taper period. N Engl J Med 330 1994; 1407-1410
    CrossrefPubMedGoogle Scholar
  • 24 Serra JG, Montenegro MA, Guerreiro MM. Antiepileptic drug withdrawal in childhood: does the duration of tapering off matter for seizure recurrence?. J Child Neurol 20 2005; 624-626
    CrossrefPubMedGoogle Scholar
  • 25 Ranganathan LN, Ramaratnam S. Rapid versus slow withdrawal of antiepileptic drugs. Cochrane Database Syst Rev 19 2006; CD005003
    PubMedGoogle Scholar
  • 26 Beghi Ettore, Giussani Giorgia, Grosso Salvatore. et al. Withdrawal of antiepileptic drugs: guidelines of the italian league against epilepsy. Epilepsia 54 suppl (07) 2013; 2-12
    CrossrefPubMedGoogle Scholar
  • 27 Michael VJohnston, Robert AGross. Clinical Use of Anti-Seizure Drugs. Principles of Drug Therapy in Neurology. 2nd ed.. 92-129
    Google Scholar
  • 28 Téllez-Zenteno JoseF, Dhar Rajat, Hernandez-Ronquillo Lizbeth, Wiebe Samuel. Long-term outcomes in epilepsy surgery: antiepileptic drugs, mortality, cognitive and psychosocial aspects. Brain 130 2007; 334-345
    CrossrefPubMedGoogle Scholar
  • 29 Park Kyung-II, Lee SangKun, Chu Kon, Jung Keun-Hwa. et al. Withdrawal of antiepileptic drugs after neocortical epilepsy surgery. Ann Neurol 67 2010; 230-238
    CrossrefPubMedGoogle Scholar
  • 30 Schiller Yitzhak, Cascino GregoryD, So ElsonL, Marsh WR. Discontinuation of antiepileptic drugs after successful epilepsy surgery. Neurology 54 2000; 346-349
    CrossrefPubMedGoogle Scholar
  • 31 Menon Ramsekhar, Rathore Chaturbhuj, Sarma SankaraP. et al. Feasibility of antiepileptic drug withdrawal following extra-temporal resective epilepsy surgery. Neurology 79 2012; 770-776
    CrossrefPubMedGoogle Scholar
  • 32 Kuruvilla A, Pandian JD, Nair M, Radhakrishnan VV, Joseph S. Neurocysticercosis: a clinical and radiological appraisal from Kerala state, South India. Singap Med J 42 2001; 297-303
    PubMedGoogle Scholar
  • 33 Verma A, Misra S. Outcome of short-term antiepileptic treatment in patients with solitary cerebral cysticercal granuloma. Acta Neurol Scand 113 2006; Mar 174-177
    CrossrefPubMedGoogle Scholar
  • 34 Thussu A, Arora A, Prabhakar S, Lal V, Sawhney IM. Acute symptomatic seizures due to single CT lesions: how long to treat with antiepileptic drugs?. Neurol India 50 2002; 141-144
    PubMedGoogle Scholar
  • 35 Gupta M, Agarwal P, Khwaja GA. et al. Randomized prospective study of outcome of short term antiepileptic treatment in small single enhancing CT lesion in brain. Neurol India 50 2002; 145-147
    PubMedGoogle Scholar
  • 36 Singh G, Rajshekhar V, Murthy JMK. et al. A diagnostic and therapeutic scheme for a solitary cysticercal granuloma. Neurology 75 2010; 2236-2245
    CrossrefPubMedGoogle Scholar
  • 37 Bousser Marie-Germaine, Ferro JoséM. Cerebral venous thrombosis: an update. Lancet Neurol 6 2007; 162-170
    CrossrefPubMedGoogle Scholar
  • 38 Ferro JoseM, Canhao Patrıcia, Bousser Marie-Germaine, Stam Jan, Barinagarrementeria F. Early seizures in cerebral vein and dural sinus thrombosis: risk factors and role of anti-epileptics. Stroke 39 2008; 1152-1158
    CrossrefPubMedGoogle Scholar
  • 39 Ferro JM, Correia M, Rosas MJ, Pinto AN, Neves G. For the cerebral venous thrombosis Portuguese Collaborative study group. Seizures in cerebral vein and dural sinus thrombosis. Cerebrovasc Dis 15 2003; 78-83
    CrossrefPubMedGoogle Scholar
  • 40 Preter M, Tzourio C, Ameri A, Bousser MG. Long-term prognosis in cerebral venous thrombosis: follow-up of 77 patients. Stroke 27 1996; 243-246
    CrossrefPubMedGoogle Scholar
  • 41 Einhaupl K, Stam J, Bousser MG. et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol 17 2010; Oct 1229-1235
    CrossrefPubMedGoogle Scholar
  • 42 Radhakrishnan Kurupathi. Medically refractory epilepsy. Radhakrishnan Kurupathi. Medically Refractory Epilepsy. 1999. SCTIMST; 1-41
    Google Scholar