Discontinuation of antiepileptic drug treatment in controlled seizure patients.

Studies on discontinuing medication in epileptic patients who have been maintaining favorable progress and who have remained free of epileptic seizures for a long period have only been reported in comparatively small numbers and the conditions necessary to evaluate such patients as well as the methods used to enable the discontinuation of antiepileptic drug treatment to be decided have not yet been established. With the recent rapid advances in the treatment of epilepsy, any long-term treatment should be designed to include the possibility that the discontinuation of medication may be possible and this possibility should be understood from the start of treatment planning. In this study, the author has attempted to gradually or completely withdraw medication from epileptic patients who maintain favorable progress, using specific criteria and methods established by the author. The criteria used were: (1) patients should have been free of epileptic seizures for three years or more, (2) no epileptic discharge had appeared on the EEG within the previous 2-3 years (recorded during sleep as well as when awake) and (3) the patient's consent should have been obtained regarding the gradual or complete withdrawal of medication. The subjects were 40 patients (23 males and 17 females) with a mean age of 32.2 years. Seizures were primary generalized tonic/clonic in type (P-GTC) in 4 patients, complex partial seizures (CPS) in 22 and generalized sleep convulsions (GC(S)) in 14. In this study, patients with absence epilepsy taking a favorable course and those with benign childhood epilepsy showing epileptic discharges in the temporal to central region (rolandic seizure) or in the occipital region were not included. If epileptic discharges appeared on EEG recordings in the course of this study during the process of gradual drug withdrawal aiming toward complete drug withdrawal, attempts to completely withdraw medication were suspended. In this study, therefore, the period before the process in which the cessation of attempts at complete withdrawal of medication was involved due to the EEG showing epileptic discharges was taken as 'the former period' and the period in which the above process was involved was taken as 'the latter period'.(ABSTRACT TRUNCATED AT 400 WORDS)