Epilepsy Follow Up

Treatment Maintenance

Drug withdrawal may be considered after the patient has been seizure-free for 3-5 years. The indications for monitoring drug levels are adjustment of drug dosage (eg Phenytoin), detection of non-compliance to the prescribed medication, management of pharmacokinetics interactions, suspected toxicity, and specific clinical situations (eg status epilepticus, organ failure). The predictors of better outcome in terms of remission from seizures are the absence of brain damage, absence of generalized tonic-clonic seizures, and absence of generalized epileptiform activity on EEG.

The frequency of seizures in the first 6 months after initial presentation is the strongest prognostic indicator. With therapy, up to 70% of patients can achieve a 5-year remission. If a patient is seizure-free after 2-5 years, drug withdrawal may be considered based on patient preference, seizure type, history, neuroimaging and electroencephalogram findings. Patients with a higher risk of seizure recurrence are those with more seizures prior to the start of therapy, with seizures after the start of therapy, with neurologic deficits, on combination therapy, with shorter seizure-free duration, with a history of myoclonus, and with abnormal neuroimaging results.

Withdraw treatment gradually, over a few months, to prevent recurrent seizures. Withdraw one drug at a time in combination therapy. Epilepsy is considered to be resolved for individuals who had an age-dependent epilepsy syndrome but are now past the applicable age or those who have remained seizure-free for the last 10 years, with no seizure medicines for the last 5 years. Lifestyle modification to reduce stress and increase treatment compliance is suggested.