When Can I Stop Epilepsy Medication? Part 1



I am dr. Jeffrey Britton I'm an adult apple apologist at Mayo Clinic in Rochester Minnesota today I'm going to talk about when to stop anti epileptic medication seizures and epilepsy are very common seizures affect roughly 5% of the population at some time in in their lives point fight to what percent of the population will have epilepsy requiring treatment 60% of the time medications currently available for treatment of epilepsy work well in stopping seizures this inevitably leads to the decision point two or three years after having ones last seizure do I still need to take my medication similar condition arises in people with high blood pressure their blood pressure gets under control with the medication in the interim they exercise lose weight pick up good habits regarding health and they may ask themselves after a few years do I still need my blood pressure medication the same situation arises in the treatment of epilepsy when it's been successfully treated with medication treatment there are several guidelines that have been published on stopping anti epileptic medication after a seizure free interval most guidelines support considering that question after two years of being seizure free some studies have looked at shorter appearance of seizure freedom one year six months etc in general a two year time frame however helps identify those who might be able to safely go off treatment two years without seizures however is far from a guarantee that things will go well off treatment and it can be very difficult to identify patients who will do well and not have seizures compared to conversely to identify those who are our greatest risk in having seizure relapse upon stop human treatment there are a number of factors that I consider when counseling patients who present to me with this problem one what do they do for a living if they drive 300 miles a week as part of their job even a 1% risk or 5% risk of a seizure may be too high to consider in that situation whereas if they have an office job there are a lot of people around plenty of people at home to be with them perhaps that person's life situation and such that taking some risk of seizure recurrence might not have as grave implications so a person's life situation is very important to me in the in the course of counseling people as to the wisdom of whether they consider stopping treatment or not there are a number of reasons why people want to stop medication if in general people don't like to take medication unless it's absolutely necessary and if they've not had a seizure for a long time they may not be so sure in their own heart of hearts whether they need to be on the treatment and they don't want to take a chemical produced by some companies somewhere for years just from a general instinctual concern about the risk of taking medications long term plus or the cost and side effects of medications that also are motivators for people to want to see to naturally inquire whether they still need to be on treatment or not if you if one looks at studies focused on the adult population in terms of relapse rate after stopping antiepileptic medication the best the best data suggests there's a 40% risk so if you take a large population of people who've had seizures on who have been seizure-free for a minimum of two years and you gradually withdraw the medication 40 percent will have a relapse at some time over the next two years if a recurrence happens it usually does so within the first year it often occurs as the medication is almost discontinued however even after the first year there still is a a lower rate of continued risk of having breakthrough seizures but the slope of that line is much less steep compared to the first year what do I look at in a person's medical condition in addition to their life situation before considering whether it's safe to stop their medication treatment several studies have analyzed risk factors to try to pick out those at greatest risk the risk factor is found to be strongest include first seizure that occurred after age 10 or 12 years of age the occurrence of a seizure type called myoclonic and generalized tonic-clonic seizures and epilepsy syndrome called juvenile myoclonic epilepsy and ramallah D's on the neurologic examination borderline intelligence level or IQ level see epilepsy that is due to a brain injury or brain lesion those factors all way the the all correlate with the increased risk of relapse if drugs are discontinued the EEG can play a role in help helping to determine those at greater risk and lower risk but there are several caveats that need to be discussed patients in whom this question arise are often on medications which can affect what's detected on the EEG so if you perform an EEG before deciding to stop a medication one has to realize the medication being taken might be affecting in suppressing the activity on the EEG so because of that the EEG is not a perfect test for this situation if you look at the presence of EEG abnormalities and the risk for relapse it does increase from 40 percent like I mentioned to about 60 percent so if the EEG abnormalities are president certainly increases the risk of relapse however if it's negative there's still about a 30 to 40 percent risk of relapse so at negative EEG does not put you out of the woods some have advocated after drugs were withdrawn doing the EEG at that point the drug is off so any effect it had on the EEG should be gone and in fact it looks like that probably does improve the yield of eg but still at the end of the day it remains an imperfect test for this clinical situation so if you went off medication in your EEG remained negative that would of course be a good thing however there would still be the you would still have some potential for relapse it wouldn't mean that you're completely free and clear

10 comments

  1. Most all seizure medicine is poison. Terrible side effects. Let me give you some keppra rage. Or take this. Might ruin your liver though.

  2. I had 2 seizure in 4 year should I take the medicine that’s the 2 time seizure I had in my all live I am 52 years old

  3. Why don't you find out what causes it and what are the triggers instead of prescribe toxins? The cause is very easy sometimes and very easy to treat it without toxic medications.

    I don't understand why neurologist don't do CBC, nutrition deficiency test, heavy metals test at first visit to rule all out those problems. So many people are epileptic and don't know why.

  4. I wish i hadnt stumbled on this video.. now i sorely regret it watching it. being born with epilepsy ..hard to control.. having constant seizure problems despite beighn on multi meds.. ending up in grandmals and violent status every time they tried removing meds. it really bites hard when being told that ill continue to have problems despite medicine and probably be stuck eatting them rest of my life.. and without treatment ill die.. i strongly resent this mans way of saying things.. as he knows NOTHING on how it makes us feel to live day to day

  5. I refuse to take medication. The side effects weren't beneficial in my case where as one would destroy my liver or [Lamictal] make me feel depressed and, after continued used, suicidal. Not to mention the sense of feeling loaded out of my mind and being put in a kind of "autopilot". I appreciate the insight on and how doctors evaluate when to pursue continued treatment.

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