A few suggestions for reducing and stopping medication in epilepsy

  What is the most important treatment concern for people with epilepsy? It is when to reduce and stop the medication. This is because 80% of patients with epilepsy can have their seizures controlled with medication, and 60% of these patients remain seizure-free after stopping medication. What should epilepsy patients pay attention to when reducing and stopping their medication?  1. Patients should be completely seizure-free for more than 2-5 years under medication before they can consider stopping medication.  2. Before deciding to discontinue medication, the risk of recurrence after discontinuation must be taken into account, therefore, a discontinuation assessment should be performed before discontinuing medication. The risk of recurrence is significantly increased in the following cases: EEG is always abnormal, more seizure types, with significant neuroimaging abnormalities and significant neurological deficits.  3. The prognosis varies among syndromes, for example, in benign syndromes in children, 1-2 years seizure-free can be considered for drug discontinuation; in juvenile clonic epilepsy, even if 5 years seizure-free, the recurrence rate is high after drug discontinuation; LG syndrome may require longer treatment time.  4. The discontinuation process should be done slowly and may last for several months or even more than 1 year.  5. In case of combined medication, only 1 drug should be reduced each time, and if there is still no seizure after at least 1 month after reducing one drug, then consider reducing the second drug.  6. If a seizure occurs during drug reduction or discontinuation, the drug should be restored to the dose before the seizure.