Withdrawing AEDs in patients with non-epileptic seizures

Antiepileptic drugs (AED) can be safely withdrawn in patients with non-epileptic seizures (NES) provided there is appropriate diagnostic investigation and monitoring.Investigators in Glasgow prospectively evaluated the safety and outcome of AED withdrawal in 78 patients diagnosed with NES (events that resemble or may be mistaken for epileptic seizures, but were not associated with abnormal EES discharges and presumed or known to be due to a psychological cause). They say that reasons why such patients should not be taking an AED include teratogenicity, cost implications of unnecessary treatment, poor outcome associated with AED continuation after diagnosis, and the potential for AEDs to actually exacerbate NES.Tapering and withdrawal of medication was generally managed in an outpatient setting and involved written and oral instructions to the patients and their GP and regular review at the authors' NES clinic. However, some patients (18%) were admitted for drug withdrawal as a result of patient or carer anxiety or because they had failed to completely withdraw as an outpatient. In the group that underwent drug withdrawal as outpatients, most followed the titration protocol as planned, but five patients (7.8%) stopped their drugs completely as soon as the diagnosis was given and two patients (3%) had their treatment stopped suddenly by their GPs. After AED withdrawal, NES frequency declined in all individuals except eight, in whom there was a transient increase. Additionally, three patients experienced new complex partial seizures in addition to NES, 14 patients reported new physical symptoms, and five patients reported new psychological symptoms. No serious adverse events were reported. The authors attribute two factors to the safe withdrawal of AEDs in NES patients: a high level of confidence that there is no underlying epilepsy and the quality of patient monitoring. They add that good information for patients and GPs is important to ensure successful AED drug withdrawal and say, "It is possible that our care in giving clear instructions to patients and their GPs contributed to the low rates of non-compliance with withdrawal advice."Reference...