Antiseizure drugs are typically continued for at least 2 years. If the patient is seizure-free after 2 years, consideration should be given to discontinuing therapy. Factors associated with high risk for recurrent seizures following drug discontinuation include EEG abnormalities, a known structural lesion, abnormalities on neurological exam, and history of frequent seizures or medically refractory seizures prior to control. Conversely, factors associated with low risk for recurrent seizures include idiopathic epilepsy, normal EEG, onset in childhood, and seizures easily controlled with a single drug. The risk of recurrent seizures is ~25% in low-risk individuals and >50% in high-risk individuals. Typically, 80% of recurrences occur within 4 months of discontinuing therapy. The clinician and patient must weigh the risk of recurrent seizure and the associated potential deleterious consequences (e.g., loss of driving privileges) against the implications of continuing medication (e.g., cost, unwanted effects, implications of diagnosis of epilepsy). Ideally, tapering is performed over a period of several months.
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