Antiepileptic Drug Withdrawal and Seizure Recurrence

Withdrawal of antiepileptic drugs (AEDs), often termed antiseizure medications (ASMs), represents a pivotal decision in the long-term management of epilepsy. Following a sustained seizure-free period, usually defined as at least two years, clinicians and patients must weigh the benefits of discontinuation—reduced side-effect burden, improved quality of life and lower healthcare costs—against the risk of seizure recurrence. Risk stratification draws on factors such as epilepsy syndrome, age at onset, seizure type, duration of seizure freedom and electroencephalographic findings. Shared decision-making frameworks emphasise individualised assessment, incorporating patient preferences, comorbidities and potential psychosocial impacts. Ongoing research seeks to refine predictive tools, identify biomarkers of relapse and optimise tapering schedules to minimise recurrence while avoiding unnecessary long-term therapy.

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Antiepileptic Drug Withdrawal and Seizure Recurrence publication trend

The graph below shows the total number of articles in antiepileptic drug withdrawal and seizure recurrence across all publications each year (not limited to Nature Index journals).

Technical terms

Antiseizure medication (ASM): A pharmaceutical agent used to prevent or reduce the frequency of epileptic seizures.

Seizure-free period: A duration, commonly at least two years, during which a patient experiences no clinical seizures while taking ASMs.

Drug tapering: The gradual reduction of ASM dosage to minimise withdrawal effects and detect early signs of seizure recurrence.

Electroencephalography (EEG): A non-invasive recording of brain electrical activity used to detect epileptiform discharges that may predict relapse.

Polytherapy: The use of two or more ASMs concurrently, often associated with more severe or refractory forms of epilepsy.

References

1. Non‐discontinuation of antiseizure medication in seizure‐free epilepsy patients. European Journal of Neurology (2023).
2. Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study. BMC Neurology (2022).
3. Risk factors for seizure recurrence after initial withdrawal of anti-seizure medications in children with epilepsy at Aga Khan University Hospital, Nairobi, Kenya.. Epilepsy & Behavior Reports (2023).