Cochrane for Clinicians

Putting Evidence into Practice

When to Discontinue Antiepileptic Drug Therapy for Patients in Remission


Am Fam Physician. 2016 Jun 1;93(11):914-915.

Author disclosure: No relevant financial affiliations.

Clinical Question

In patients with a history of epilepsy, how long must one be seizure-free before stopping antiepileptic drug therapy?

Evidence-Based Answer

Children with epilepsy should be seizure-free for at least two years before stopping antiepileptic drug therapy, especially those who have partial seizures or a history of abnormal electroencephalography (EEG) results. Evidence is insufficient to guide this decision for children with generalized seizures, and there is no evidence with which to answer this question for adults. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Patients sometimes present to their family physician requesting discontinuation of their seizure medication, yet doing so prematurely can be harmful. A detailed history is important to establish whether seizures were focal (partial) or generalized (involving bilateral hemispheres of the brain), and whether consciousness was impaired. Attempts should be made to retrieve EEG or imaging study results. Furthermore, some patients may have had nonepileptic (psychogenic) seizures or seizures provoked by a resolved stimulus (e.g., fever, alcohol or drug withdrawal).1

The authors of this Cochrane review assessed the risk of discontinuing antiepileptic drug therapy in children and adults with true epilepsy. They defined epilepsy as two or more unprovoked seizures at least 24 hours apart, one seizure with very high risk of recurrence because of an underlying condition, or a diagnosis of epilepsy syndrome. The authors searched for randomized controlled trials comparing patients with epilepsy who underwent early (less than two continuous years seizure-free) vs. late (two or more years seizure-free) withdrawal of antiepileptic drugs. Neonates were excluded. Five trials with a total of 924 children were ultimately included in the meta-analysis; the most recent trial was published in 2000.

Four of the trials were conducted in affluent European c

Author disclosure: No relevant financial affiliations.


show all references

1. Wilden JA, Cohen-Gadol AA. Evaluation of first nonfebrile seizures. Am Fam Physician. 2012;86(4):334–340....

2. American Academy of Neurology Quality Standards Subcommittee. Practice parameter: a guideline for discontinuing antiepileptic drugs in seizure-free patients—summary statement. Neurology. 1996;47(2):600–602.

3. Beghi E, Giussani G, Grosso S, et al. Withdrawal of antiepileptic drugs: guidelines of the Italian League Against Epilepsy. Epilepsia. 2013;54(suppl 7):2–12.

4. Hixson JD. Stopping antiepileptic drugs: when and why? Curr Treat Options Neurol. 2010;12(5):434–442.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at



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