Abstracts

Gradual tapering of anti-convulsant medications in two-year seizure-free patients with partial and secondarily generalized epilepsy is a commonly accepted practice among neurologists and epileptologists but little is known about patients[apos] compliance to achieve this approach.
In a prospective study, the selection criteria was as follows: Only patients with partial onset epilepsy, with or without secondarily generalized tonic-clonic seizures, who were seizure-free for two years, who were on monotherapy, who had updated normal brain magnetic resonance imaging (MRI) with and without contrast, and who had a current electroencephalogram (EEG) without clinical and electrographic epileptiform activity. The tapering of the anti-convulsant medication was elicited in a period of 8 to 12 weeks.
From June 12, 2001, to April 4, 2003, twenty-five epileptic patients fulfilled the selection criteria. Thirteen (52%) patients were seizure-free for two years, had normal brain MRI but abnormal EEG and could not be tapered from their anti-epileptic medication despite their wishes. Eight (32%) patients were seizure-free for two years, had normal brain MRI and normal EEG but they were afraid to undergo the tapering of their anti-convulsant drug. Three (12%) patients were seizure-free for two years, had normal brain MRI and normal EEG, requested the tapering of their anti-epileptic medication and remained seizure-free. One (4%) patient was seizure-free for two years, had normal brain MRI and normal EEG, requested the tapering of his anti-convulsant drug but, six months later, had a generalized tonic seizure.
It appears from this brief study that the major factor in the tapering of anti-convulsant drugs in two-year seizure-free epileptic patients is their willingness itself. Due to their pessimism, many patients will never know if they could have remained seizure-free without their anti-epileptic medication.
Despite their optimism, some patients will learn that the risk of recurrent seizures continues to be a threat.