In December of 2008, the journal Epilepsia (Camfield P, Camfield C. When is it safe to discontinue AED treatment? Epilepsia. 2008; volume 49, Supplement 9, pages 25-8) published a review of when to consider tapering (eliminating) antiepileptic medications. A previous analysis by the American Academy of Neurology concluded that 69% of children and 61% of adults could taper their AEDs without having seizures. The flip side is that about one-third did have seizures. Chadwick pointed out that removing AEDs doubles the risk of having a seizure over the next 1-2 years. The Camfield’s showed that, when seizures do relapse, after stopping AEDs in children, control can be regained in 97%. Certain epilepsy conditions, for example, juvenile myoclonic epilepsy are unlikely to go away, and for these conditions AEDs should usually not be stopped. The authors of the review conclude that most children can be considered to come off AEDs after being seizure-free for 1-2 years; adults after about 4 years. Epilepsy.com adds that tapering typically is done over one to a few months, and only in conjunction with your physician. Update of the EEG may give guidance as to whether tapering is likely to be successful. Special safety precautions, such as a pause on driving, may be recommended. Please - do not stop your medicines on your own.

Robert Fisher, M.D., Ph.D.
Editor-in-Chief