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AAN guideline on withdrawing anticonvulsants in seizure-free adults and children
Clinical Question
Can anticonvulsants be withdrawn in seizure-free persons?
Bottom line
For the most part, the AAN recommends shared decision-making to decide whether to withdraw anticonvulsants among adults and children who have been seizure-free. Now, it would be helpful if they would provide good tools to guide this decision-making. 5
Reference
Study design: Practice guideline
Funding: Foundation
Setting: Various (guideline)
Synopsis
To update its 1996 recommendations on anticonvulsant withdrawal, the American Academy of Neurology (AAN) convened a panel of general AAN members, clinicians with expertise in epilepsy, and a methodologist — no patients or primary care clinicians. The AAN tried to minimize conflicts of interest among the panelists. The panel used systematic reviews to inform their recommendations. The panel addressed various outcomes mostly after 12 months or more of withdrawal: seizure recurrence, quality of life, mortality, and status epilepticus. One of the problems with the data was the variability in seizure-free intervals used in the reviews: 12 to 60 months. Ultimately, the panel recommended that adults who have been seizure-free for at least 24 months should engage in shared decision-making with their clinicians to determine the benefits and harms of continuing anticonvulsants. The panel could draw no conclusions as to the utility of electroencephalograms or other imaging in guiding these decisions among adults. The panel also could make no recommendations about medication withdrawal after epilepsy surgery. Among children who have abnormal electroencephalograms, the panel does not recommend medication withdrawal. Otherwise, in children who have been seizure-free for 18 to 24 months, the panel recommends shared decision-making to determine the benefits and harms of continuing anticonvulsants. Finally, the panel identified several areas in need of research.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
SEIZURE
I was hoping with good guidline , they acutualy increase seizure free period
and made no comment with positive EEG
I am waitting for more study.
Till then share decision will be made by patient neurologist and me as neurosurgeon.
When there is intolerance we me stop medication but recomend to avoid stimulent and driving
AAN guideline on withdrawing anticonvulsants in seizure-free
the title of the guideline fails to clarify that it refers only to withdrawing anticonvulsants in people with a history of Epilepsy, given that anticonvulsants are also a mainstay of treatment for people with Bipolar Disorder, which is more than twice as prevalent (2.8% vs 1.2%). Also, the concluding recommendation for 'shared decision making', merely states the obvious, since its what doctors should be doing anyway. Hence, its hard to see that this guideline really contributes anything to our knowledge.
stopping anticonvulsants
may consider tapering and stopping meds if seizure free 24 months