Please use this identifier to cite or link to this item:
Title: Should antiseizure medications be withdrawn after an extended period of seizure freedom in individuals with adult-onset epilepsy?
Austin Authors: Mesraoua, Boulenouar;Perucca, Emilio;Tomson, Torbjorn;Asadi-Pooya, Ali A
Affiliation: Neurosciences Department, Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar.
Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
Medicine (University of Melbourne)
Issue Date: May-2023
Date: 2023
Publication information: Epilepsy & Behavior : E&B 2023; 142
Abstract: Unlike several epilepsies with onset in pediatric age, adult-onset epilepsies do not typically have a time course that is predictably self-remitting in the large majority of people. Still, about one-half of individuals with adult-onset epilepsy who have been seizure-free for an extended period (two years or longer) on antiseizure medications (ASMs) will remain in remission when their drug therapy is discontinued. Although a number of predictors of outcome have been identified (including specific adult-onset syndromes associated with a low probability of spontaneous remission), in most cases, the only way to establish whether the epilepsy has remitted in a given individual is to gradually withdraw ASMs. ASM withdrawal can be beneficial, particularly when the currently used treatment is not well tolerated, or could lead to adverse outcomes in the future (i.e., teratogenic effects should pregnancy occur in a female of childbearing potential). However, the risks associated with ASM withdrawal are significant. Relapse of seizures can have major adverse psychosocial consequences and also may carry a risk of morbidity and mortality. Most importantly, evidence suggests that in about 20% of individuals whose seizure relapsed following ASM withdrawal, re-institution of pharmacological therapy may not readily restore seizure control. Ultimately, management decisions should prioritize the preference of the well-informed person with epilepsy. Particularly, when adverse drug effects are a concern, options to be discussed should include not only withdrawal or continuation of the current treatment but also dose reduction or substitution with a different ASM.
DOI: 10.1016/j.yebeh.2023.109205
Journal: Epilepsy & Behavior : E&B
Start page: 109205
PubMed URL: 37031583
ISSN: 1525-5069
Type: Journal Article
Subjects: Antiseizure medications
Drug withdrawal
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on Dec 5, 2023

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.