What does the National Institute of Health say?
AED discontinuation may be considered in patients whose seizures have been completely controlled for a prolonged period, typically 1 to 2 years for children and 2 to 5 years for adults.
Most neurologists would agree that having at a minimum:
A Routine EEG before weaning a patient off of seizure medications followed by a doctor’s appointment 3-4 months after the wean would be beneficial for seizure patients.
However, many neurologists do more than the minimum; so, of course, the doctor’s order is what would drive the process:
Some would prefer a longer test before the wean and
Some would also prefer post wean testing but only after discussing any symptoms with the patient first or
Some would prefer a follow up procedure (Routine or Ambulatory) after the wean and before they see the patient in order to get ahead of any symptoms.
Some additional helpful parameters that some Neurologists may follow:
Testing ordered depends on the type of epilepsy: Generalized epilepsy vs Focal epilepsy.
Testing including an Ambulatory study for both before and after since a Routine test might not capture all stages that are needed or might not be long enough.
Patient’s on Depakote should get a follow up test since Depakote can often ‘clean up’ the EEG.
Absence seizure patient’s should get 1 Day ambulatory tests before and post wean since often parents and patient’s are unaware if they are having seizures.
Patient’s of driving age or close to driving age should get longer tests to be sure they are ready and to be sure they are ok afterwards.
Patient’s that have failed a medication wean in the past should get longer pre and post tests.
Studies show that the rate of seizure recurrence after AED withdrawal is about two to three times the rate in patients who continue AEDs, but there are many benefits to AED withdrawal that should be evaluated on an individualized basis.
As always, patients should talk to their doctor for best treatment recommendations.
Roya Tompkins, MS, REEG/EP T, RPSGT
Resources: National Institute of Health (for full article click here)
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