Practice Parameter

The Quality Standards Subcommittee of the American Academy of Neurology (AAN) develops practice parameters for neurologists pertaining to diagnostic procedures, treatment modalities, and clinical disorders. The selection of topics is based on prevalence or frequency of use; potential for improving health outcomes; and reducing variations in practice patterns, economic impact, and adequacy of scientific evidence. Whether and when to withdraw antiepileptic drugs (AEDs) is a common problem in the management of patients with epilepsy. This decision is often made in the absence of data. The following guideline is intended to help physicians in their decisions to withdraw AEDs. When a patient with a history of epileptic seizures has remained seizure-free for a period of years, the question arises whether to continue or reduce AEDs. The decision to withdraw AEDs is often made in the absence of data; choice of patients and timing of the discontinuance are often not based on well-defined criteria. This problem has been the subject of many retrospective and prospective investigations. Criteria for selecting patients to study and the procedures for ensuring continued follow-up vary greatly. Thus, results of these investigations are not uniform and are not easily compared. Even in prospective studies, it is not possible to control all factors relevant to discontinuance of medication. Nevertheless, the documented experiences presented in these studies are useful in constructing a guide to practice. We conducted a MEDLINE search for the years 1967 to 1991 using the key words \``discontinuance of antiepileptic drugs,'' \`\`prognosis of epilepsy,'' \`\`relapse/recurrence,'' and \``remission.'' Studies of both children and adults were included and were considered separately. We reviewed all articles in their entirety, attempting to identify common …