When to Stop Antiseizure Medications in Adults? 

Are you waiting to stop the bothersome long-term antiseizure medications yet afraid of possible recurrence of seizures?

To make the right decision in this dilemma, you should know the details on when and how to stop your medications and the possible consequences.  

Treating epilepsy is a long-term commitment lasting for years, yet the good news is seizures can be well controlled in 60-80% of these patients by medications.

Therefore, continuing the medications is worth ensuring your own safety because seizures can be dangerous, leading to injuries, accidents, and even death. Furthermore, the longer you will be without seizures, the more they will be asleep and not come back because simply the brain "forgets how to seize."

However, stopping medications is very convenient as it not only takes away the burden of being on drugs and their side effects but also strikes off the stigma, cost of medications, their long-term effects on the body, and interactions with the other medications. During pregnancy, antiseizure medicines may cause adverse effects on the baby too. Overall, people who stop their medications are happier and lead a better quality of life.

However, only those who have had absolutely no seizures for multiple years can consider stopping their medications. Furthermore, there is a 40-60% risk of getting a recurrence of seizures and most of these attacks will happen in the first year after stopping medications. Hence never stop the antiseizure medicine on your own without analyzing the seven main predictors of seizure recurrence. 

• Age when the seizure started – Very early seizures at birth have a high risk of recurrence. Also, the older onset seizures are more likely to come back as the cause of epilepsy usually is more permanent in older age.
• Duration of epilepsy – You should be free from seizures for at least two years to consider stopping medications. The more we wait from there, the better the outcome will be.
• Cause of seizures - If the cause of the seizure is head trauma, bleeding in the brain, or stroke, these leave scars in the brain and have a very high risk of recurrence because the medicine only calms down the electricity in the scar, but will never clear out the scar.
• Seizure type and frequency of seizures - Generalized seizures have a better chance of remission than focal seizures, and the worst is multiple types of focal seizures. If there were more than ten seizures before they got under control, it is more likely to recur.
  
• Developmental delay and a family history of epilepsy raise the risk of seizure recurrence.
  
• Medication use - If your seizures demand multiple medications to get under control, they are more likely to come back after stopping treatment.
• EEG – If EEG shows epileptiform discharges or focal slowing, there is an increased risk of seizure recurrence. Since antiseizure medications can suppress EEG in case of normal EEG, it is worth repeating it after stopping the medication.

The decision to stop the medicine should be tailor-made and individualized according to the lifestyle. Especially if you are in a high-risk occupation like driving, refrain from it while tapering the medications.

The taper time is usually between six weeks to nine months, and the best results are seen around 3-4 months. If you are taking multiple medications, slowly taper each medicine alone.

It is true that ultimately you got to discuss with your doctor to stop the antiseizure medications. But being equipped with all the relevant details empowers you to arrive at an informed decision on your own health. 

Another tool that can be used by your doctor is this calculator which you put in all the details of your seizures and testing results, and it will give you the estimated risk of seizures coming back in the next 2 and 5 years. Use it with caution and under your doctor’s supervision. The calculator can be found in this website: http://epilepsypredictiontools.info