Antiepileptic drugs discontinuation

Jacoby A, Johnson A, Chadwick D. Psychosocial outcomes of antiepileptic drug discontinuation. Epilepsia 1991 33 1123-31. 

Determine when and how to discontinue antiepileptic drug therapy. 

Discontinuation of antiepileptic drugs should be done gradually, only after the patient has been seizure-free for 2 to 5 years and with careful consideration of factors predictive of seizure recurrence. 

Patient Encounter 3, Discontinuing Antiepileptic Drug Therapy ... 

What additional information would be helpful to determine the possibility of discontinuing his antiepileptic drugs ... 

If the antiepileptic drugs are stopped, how should they be discontinued ... 

Withdrawai-precipitated seizure Antiepileptic drugs should not be abruptly discontinued because of the possibility of increasing seizure frequency. 

Also, if concomitant enzyme-inducing antiepileptic drugs such as carbamazepine, phenobarbital, phenytoin, and primidone are discontinued after lamotrigine dose is stabilized, then the lamotrigine dose should be maintained for 1 week following discontinuation of the other drug and then reduced by half over 2 weeks in equal decrements each week... 

In an open study of the effects of topiramate 100-1600 mg/day in 292 adults (mean age 33 years) with partial and/or generalized seizures previously resistant to antiepileptic drug therapy over 50% of the patients achieved at least a 50% reduction in seizures (1). The most commonly reported adverse events were related to the central nervous system, including headache, difficulty in concentrating, somnolence, anorexia, fatigue, dizziness, nervousness, nausea, confusion, and paresthesia 32% discontinued because of adverse events. 

Some patients eventually can discontinue antiepilelptic drug therapy. Several factors predict successful withdrawal of antiepileptic drugs. 

After assessing the risks and benefits to both patient and society from a recurrent seizure, the discontinuance of antiepileptic drugs may be considered by the physician and informed patient or parent/guardian if the patient meets the following profile ... 

Shinnar S, Gross-Tsur V. Discontinuing antiepileptic drug therapy. In Wyllie E, ed. The Treatment of Epilepsy, 3d ed. Philadelphia, Lippincott Williams Wilkins, 2001 811-819. 

Schiller Y, Casino GD, So EL, Marsh R. Discontinuation of antiepileptic drugs after successful epilepsy surgery. Neurology 2000 54 346-349. 

The client diagnosed with epilepsy has undergone a spontaneous remission of the epilepsy, a rare but occasional occurrence. What information should the nurse discuss with the client when discontinuing antiepileptic drugs ... 

Observational studies Pregabalin has been evaluated in an open 21-week study in 476 adults (mean age 40 years) with partial seizures inadequately controlled with one to three antiepileptic drugs 7% discontinued for lack of efficacy and 12% because of adverse events [247 ]. The three most common adverse reactions were dizziness (17%), somnolence (13%), and weight gain (13%). 

IRINOTECAN 1. ANTIBIOTICS-rifampicin 2. ANTICANCER AND IMMUNOMODULATING DRUGS - dexamethasone 3. ANTIDEPRESSANTS-St John s wort 4. ANTIEPILEPTICS-carbamazepine, phenobarbital, phenytoin i plasma concentrations of Irinotecan and risk of i therapeutic efficacy. The effects may last for 3 weeks after discontinuation of CYP-inducer therapy Due to induction of CYP3A4-mediated metabolism of irinotecan Avoid concomitant use when ever possible if not, t dose of irinotecan by 50%... 

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