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How risky is stopping epilepsy drugs?

Q A patient who has been fit-free for five years has asked if he can stop his anti-epilepsy drug. How should I advise him?

A About 1 per cent of the population have epilepsy, but about 70 per cent become seizure-free on medication. Exhaustive studies show that after a mean of 3.2 years of seizure freedom, 78 per cent of patients would still be seizure-free after a further two years if they stayed on medication, whereas

59 per cent would if they withdrew. Peak risk is

about nine months after withdrawal.

The longer a person has been seizure-free on anti-epileptic drugs, the better their prognosis.

Seizure freedom for five to 10 years gives two-thirds

of the risk of seizure recurrence associated with seizure freedom of two to three years.

Factors that increase the risks of recurrence include age of onset (over 16); taking more than one anti-epileptic drug (AED); seizures occurring after initiation of an AED; a history of tonic-clonic seizures; a history of myoclonic seizures; an abnormal EEG.

A relative risk of recurrence can be roughly worked out on the basis of these factors.

At five years seizure-free, on one AED and with one or two of the above risk factors, the likelihood of recurrent seizures on withdrawal is about 20 to 30 per cent, compared with 10-15

per cent risk without withdrawal.

At 10 years the risk would drop to perhaps 10 per cent and 5 per cent.

The patient can then be counselled to take into account the need to be seizure-free as far as possible for, say, work or driving.

Dr Jonathan Bird is consultant neuropsychiatrist,

Burden Centre for Neuropsychiatry, Frenchay Hospital, Bristol

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