Stopping drug therapy in epilepsy

In most of the epilepsies and epileptic syndromes, the decision to initiate antiepileptic drug (AED) therapy is often a far simpler one than the decis ion to stop it. The primary factor that drives a patient to want to discont inue therapy, and a doctor to endorse or recommend this, is a fear of long- term adverse events, a consideration that may be entirely justified as the side effects of vigabatrin and felbamate have proved. On the other hand, se izure recurrence with the attendant implications in employment, driving reg ulations and social stigmatization is a strong deterrent that discourages w ithdrawal of therapy. The absence of a clearer understanding of the natural history and prognosis of many individual epilepsy syndromes somewhat hampe rs the resolution of this dilemma. Hopefully, as our understanding of the e pilepsies grows and the prediction of the chances of seizure relapse become s a more precise science, stopping medication will become a less fraught ex ercise for both the patient and the doctor.