The Pharmaceutical Journal
Vol 271 No 7256 p8
5 July 2003

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Drug and Therapeutics Bulletin (more)

Consider ending epilepsy drugs when seizure-free

There is good reason to consider stopping antiepileptic medication in adults who have been free of seizures for two years, according to the Drug and Therapeutics Bulletin. About 60 per cent of these patients will have no further seizures when their medicine is withdrawn.

The latest issue of the bulletin discusses whether or not antiepileptic drugs should be stopped in adults. It points out that patients with epilepsy controlled by drug treatment may want to stop their medication either because they believe it is no longer necessary or because they want to avoid unwanted effects of the drugs.

In general, the risk of seizure recurrence is higher in patients whose epilepsy started after childhood, and in those who are taking more than one antiepileptic drug. Withdrawal should be gradual, with doses reduced by 10 per cent every two to four weeks for carbamazepine, lamotrigine, phenytoin, sodium valproate and vigabatrin, and 10 per cent every four to eight weeks for barbiturates, benzodiazepines and ethosuximide.

The bulletin recommends that for women planning a baby any changes to medication should be done before conception. Furthermore, women with epilepsy should take 5mg folic acid daily before conception and during the first trimester whether or not antiepileptic drugs are discontinued (2003;41:41).