When Can You Set Free Your Child from Antiseizure Medications?

A child’s health becomes the utmost priority of any parent. Giving regular antiseizure medications to children over a long time is not an easy task. This struggle makes you wonder whether you can stop these medications. 
Stopping antiseizure medication in children is completely different than in adults because the causes of seizures are different. Besides, the brain in children is still developing and changing, and so does epilepsy.
The good news is that medications can control seizures in 60-80% of those with epilepsy. After stopping the medications, the overall risk of seizure recurrence is about 40-60%, most of which will happen within the first year of withdrawing the medicine. However, restarting the medication will bring satisfactory control over the seizures in about 90% of these cases. So, there is a chance that seizures might not get controlled again, and you should know this before deciding to stop the treatment. Stopping antiseizure medications can also very rarely put the child at the risk of status epilepticus, which is long seizures that can be life-threatening and even causes death. 
Stopping antiseizure medications when appropriate is worth it because children tend to outgrow the tendency to have seizures as they grow older and hence can avoid the medication-induced cognitive impairments.
Recent guidelines by the American Academy of Neurology recommended considering stopping antiseizure medications in children between 18 and 24 months of seizure freedom. It also disclosed that there was no difference in the results when waiting for 2 or 4 years. Thus, we can start thinking about stopping medications after two years of being seizure-free.

Seven predictors of seizure recurrence

Be aware that the seizures can recur after stopping the medication due to various risk factors.

• EEG – Before stopping the medicine, your doctor will do an EEG. If there is still epileptiform activity seen, meaning there is still excess electricity, without the medications, it will grow back into seizures.
• Cause of seizures – Syndromes like Benign Rolandic Epilepsy and Childhood Absence Epilepsy will stop having seizures as the children get older and “outgrow the seizures.” Whereas some seizures, like Juvenile Myoclonic Epilepsy, continue for longer.
• Age when the seizures started – Seizures starting at 3-4 years of age are least likely to come back. Very early seizures at birth and those occurring late in the mature brain have a high risk of recurrence.
• Duration of epilepsy – The longer it takes to control the seizures in the first place, the more likely they will come back.
• Seizure type and frequency of seizure – Generalized seizures have a better chance of remission than focal seizures, and the worst is multiple types of focal seizures. The number of seizures before remission is crucial, and if the child had more than ten seizures before they got under control, then it is more likely that they will reappear.
• Developmental delay, family history of epilepsy, and febrile seizures have a higher risk of seizure recurrence.
• Medication use – If more medications are needed to control, the more likely the seizures will re-emerge after stopping them.

Stop the medicines one by one and have at least a 2-3 months weaning schedule for each medication. Children are not small adults, and each child is unique. Hence it is crucial to consult the treating doctor first, and medical supervision is essential throughout the entire process.  
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